PROFARM GROUP, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PROFARM GROUP HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2021: PROFARM GROUP HEALTH AND WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-11-01 | 124 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 111 |
Number of retired or separated participants receiving benefits | 2021-11-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 0 |
Total of all active and inactive participants | 2021-11-01 | 111 |
Number of employers contributing to the scheme | 2021-11-01 | 0 |
2020: PROFARM GROUP HEALTH AND WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-11-01 | 111 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 114 |
Number of retired or separated participants receiving benefits | 2020-11-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2020-11-01 | 7 |
Total of all active and inactive participants | 2020-11-01 | 124 |
Number of employers contributing to the scheme | 2020-11-01 | 0 |
2019: PROFARM GROUP HEALTH AND WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-11-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 111 |
Number of retired or separated participants receiving benefits | 2019-11-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 0 |
Total of all active and inactive participants | 2019-11-01 | 113 |
Number of employers contributing to the scheme | 2019-11-01 | 0 |
2018: PROFARM GROUP HEALTH AND WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-11-01 | 100 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 108 |
Number of retired or separated participants receiving benefits | 2018-11-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-11-01 | 0 |
Total of all active and inactive participants | 2018-11-01 | 108 |
Number of employers contributing to the scheme | 2018-11-01 | 0 |
2017: PROFARM GROUP HEALTH AND WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-11-01 | 100 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 104 |
Number of retired or separated participants receiving benefits | 2017-11-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-11-01 | 0 |
Total of all active and inactive participants | 2017-11-01 | 104 |
Number of employers contributing to the scheme | 2017-11-01 | 0 |
2014: PROFARM GROUP HEALTH AND WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-12-01 | 120 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 85 |
Number of retired or separated participants receiving benefits | 2014-12-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2014-12-01 | 0 |
Total of all active and inactive participants | 2014-12-01 | 88 |
2013: PROFARM GROUP HEALTH AND WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-12-01 | 106 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 120 |
Number of retired or separated participants receiving benefits | 2013-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-12-01 | 0 |
Total of all active and inactive participants | 2013-12-01 | 120 |
2012: PROFARM GROUP HEALTH AND WELFARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-12-01 | 100 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 106 |
Number of retired or separated participants receiving benefits | 2012-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-12-01 | 0 |
Total of all active and inactive participants | 2012-12-01 | 106 |
2021: PROFARM GROUP HEALTH AND WELFARE PLAN 2021 form 5500 responses |
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2021-11-01 | Type of plan entity | Single employer plan |
2021-11-01 | Plan funding arrangement – Insurance | Yes |
2021-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-11-01 | Plan benefit arrangement – Insurance | Yes |
2021-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: PROFARM GROUP HEALTH AND WELFARE PLAN 2020 form 5500 responses |
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2020-11-01 | Type of plan entity | Single employer plan |
2020-11-01 | Plan funding arrangement – Insurance | Yes |
2020-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-11-01 | Plan benefit arrangement – Insurance | Yes |
2020-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: PROFARM GROUP HEALTH AND WELFARE PLAN 2019 form 5500 responses |
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2019-11-01 | Type of plan entity | Single employer plan |
2019-11-01 | Plan funding arrangement – Insurance | Yes |
2019-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-11-01 | Plan benefit arrangement – Insurance | Yes |
2019-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: PROFARM GROUP HEALTH AND WELFARE PLAN 2018 form 5500 responses |
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2018-11-01 | Type of plan entity | Single employer plan |
2018-11-01 | Plan funding arrangement – Insurance | Yes |
2018-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-11-01 | Plan benefit arrangement – Insurance | Yes |
2018-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: PROFARM GROUP HEALTH AND WELFARE PLAN 2017 form 5500 responses |
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2017-11-01 | Type of plan entity | Single employer plan |
2017-11-01 | Plan funding arrangement – Insurance | Yes |
2017-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-11-01 | Plan benefit arrangement – Insurance | Yes |
2017-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: PROFARM GROUP HEALTH AND WELFARE PLAN 2014 form 5500 responses |
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2014-12-01 | Type of plan entity | Single employer plan |
2014-12-01 | Submission has been amended | No |
2014-12-01 | This submission is the final filing | No |
2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-12-01 | Plan is a collectively bargained plan | No |
2014-12-01 | Plan funding arrangement – Insurance | Yes |
2014-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-12-01 | Plan benefit arrangement – Insurance | Yes |
2014-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: PROFARM GROUP HEALTH AND WELFARE PLAN 2013 form 5500 responses |
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2013-12-01 | Type of plan entity | Single employer plan |
2013-12-01 | Submission has been amended | No |
2013-12-01 | This submission is the final filing | No |
2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-12-01 | Plan is a collectively bargained plan | No |
2013-12-01 | Plan funding arrangement – Insurance | Yes |
2013-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-12-01 | Plan benefit arrangement – Insurance | Yes |
2013-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: PROFARM GROUP HEALTH AND WELFARE PLAN 2012 form 5500 responses |
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2012-12-01 | Type of plan entity | Single employer plan |
2012-12-01 | First time form 5500 has been submitted | Yes |
2012-12-01 | Submission has been amended | No |
2012-12-01 | This submission is the final filing | No |
2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-12-01 | Plan is a collectively bargained plan | No |
2012-12-01 | Plan funding arrangement – Insurance | Yes |
2012-12-01 | Plan benefit arrangement – Insurance | Yes |
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 754664 |
Policy instance | 3 |
Insurance contract or identification number | 754664 | Number of Individuals Covered | 114 | Insurance policy start date | 2021-11-01 | Insurance policy end date | 2022-10-31 | Total amount of commissions paid to insurance broker | USD $14,576 | Total amount of fees paid to insurance company | USD $7,071 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,576 | Amount paid for insurance broker fees | 7071 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 2 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 45 | Insurance policy start date | 2021-11-01 | Insurance policy end date | 2022-10-31 | Total amount of commissions paid to insurance broker | USD $12,827 | Total amount of fees paid to insurance company | USD $429 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $308,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,827 | Amount paid for insurance broker fees | 429 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0028843 |
Policy instance | 1 |
Insurance contract or identification number | W0028843 | Number of Individuals Covered | 150 | Insurance policy start date | 2021-11-01 | Insurance policy end date | 2022-10-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $82,233 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,562,355 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 82233 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 754664 |
Policy instance | 3 |
Insurance contract or identification number | 754664 | Number of Individuals Covered | 114 | Insurance policy start date | 2020-11-01 | Insurance policy end date | 2021-10-31 | Total amount of commissions paid to insurance broker | USD $14,007 | Total amount of fees paid to insurance company | USD $4,214 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,007 | Amount paid for insurance broker fees | 4214 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 2 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 49 | Insurance policy start date | 2020-11-01 | Insurance policy end date | 2021-10-31 | Total amount of commissions paid to insurance broker | USD $12,909 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $258,544 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,909 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0028843 |
Policy instance | 1 |
Insurance contract or identification number | W0028843 | Number of Individuals Covered | 155 | Insurance policy start date | 2020-11-01 | Insurance policy end date | 2021-10-31 | Total amount of commissions paid to insurance broker | USD $62,591 | Total amount of fees paid to insurance company | USD $70,040 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,320,820 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 70040 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0028843 |
Policy instance | 1 |
Insurance contract or identification number | W0028843 | Number of Individuals Covered | 144 | Insurance policy start date | 2019-11-01 | Insurance policy end date | 2020-10-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $130,751 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,292,759 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 69515 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES BONUS OVERRIDE | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 2 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 53 | Insurance policy start date | 2019-11-01 | Insurance policy end date | 2020-10-31 | Total amount of commissions paid to insurance broker | USD $13,542 | Total amount of fees paid to insurance company | USD $600 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $270,675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,542 | Amount paid for insurance broker fees | 600 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 754664 |
Policy instance | 3 |
Insurance contract or identification number | 754664 | Number of Individuals Covered | 106 | Insurance policy start date | 2019-11-01 | Insurance policy end date | 2020-10-31 | Total amount of commissions paid to insurance broker | USD $13,509 | Total amount of fees paid to insurance company | USD $6,311 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,509 | Amount paid for insurance broker fees | 6311 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 754664 |
Policy instance | 3 |
Insurance contract or identification number | 754664 | Number of Individuals Covered | 121 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-31 | Total amount of commissions paid to insurance broker | USD $12,953 | Total amount of fees paid to insurance company | USD $5,928 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,953 | Amount paid for insurance broker fees | 5928 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 2 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 48 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-31 | Total amount of commissions paid to insurance broker | USD $18,275 | Total amount of fees paid to insurance company | USD $764 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $247,615 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,275 | Amount paid for insurance broker fees | 764 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0028843 |
Policy instance | 1 |
Insurance contract or identification number | W0028843 | Number of Individuals Covered | 162 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-31 | Total amount of commissions paid to insurance broker | USD $58,937 | Total amount of fees paid to insurance company | USD $65,992 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,237,263 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $330 | Amount paid for insurance broker fees | 65992 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES BONUS OVERRIDE | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 754664 |
Policy instance | 3 |
Insurance contract or identification number | 754664 | Number of Individuals Covered | 101 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-10-31 | Total amount of commissions paid to insurance broker | USD $5,562 | Total amount of fees paid to insurance company | USD $1,702 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $111,247 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10222497 |
Policy instance | 4 |
Insurance contract or identification number | 10222497 | Number of Individuals Covered | 105 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-10-31 | Total amount of commissions paid to insurance broker | USD $1,098 | Total amount of fees paid to insurance company | USD $1,608 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $17,035 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 2 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 38 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-10-31 | Total amount of commissions paid to insurance broker | USD $12,312 | Total amount of fees paid to insurance company | USD $523 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $176,624 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0028843 |
Policy instance | 1 |
Insurance contract or identification number | W0028843 | Number of Individuals Covered | 153 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-10-31 | Total amount of commissions paid to insurance broker | USD $100,539 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,091,699 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 403181 |
Policy instance | 5 |
Insurance contract or identification number | 403181 | Number of Individuals Covered | 33 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $2,199 | Total amount of fees paid to insurance company | USD $54 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $14,664 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,083 | Amount paid for insurance broker fees | 54 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | WOO28843 |
Policy instance | 4 |
Insurance contract or identification number | WOO28843 | Number of Individuals Covered | 126 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $51,083 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $836,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,446 | Insurance broker organization code? | 3 | Insurance broker name | WOODRUFF-SAWYER AND COMPANY |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 3 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 46 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $16,551 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $227,453 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,224 | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ATQ1 |
Policy instance | 1 |
Insurance contract or identification number | GLUG0ATQ1 | Number of Individuals Covered | 88 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $2,177 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $21,764 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,183 | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05995721 |
Policy instance | 2 |
Insurance contract or identification number | KM05995721 | Number of Individuals Covered | 261 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $6,640 | Total amount of fees paid to insurance company | USD $713 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $138,727 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,421 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 713 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker name | WOODRUFF-SAWYER AND COMPANY |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | WOO28843 |
Policy instance | 2 |
Insurance contract or identification number | WOO28843 | Number of Individuals Covered | 175 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $39,108 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $919,087 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $39,108 | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 1 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 61 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $26,173 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $375,177 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,173 | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05995721 |
Policy instance | 3 |
Insurance contract or identification number | KM05995721 | Number of Individuals Covered | 261 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $7,886 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $140,411 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,886 | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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SAFEGUARD HEALTH PLANS INC (National Association of Insurance Commissioners NAIC id number: 79014 ) |
Policy contract number | 97379406 |
Policy instance | 4 |
Insurance contract or identification number | 97379406 | Number of Individuals Covered | 135 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $1,303 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $7,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,303 | Insurance broker organization code? | 3 | Insurance broker name | OWENS AND COMPANY |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 403181 |
Policy instance | 5 |
Insurance contract or identification number | 403181 | Number of Individuals Covered | 36 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $2,746 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,304 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,746 | Insurance broker organization code? | 3 | Insurance broker name | OWEN AND COMPANY |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | WB5909 ET AL |
Policy instance | 3 |
Insurance contract or identification number | WB5909 ET AL | Number of Individuals Covered | 64 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $42,984 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $632,057 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,984 | Insurance broker organization code? | 3 | Insurance broker name | OWEN-DUNN INSURANCE SERVICES |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05995721 |
Policy instance | 2 |
Insurance contract or identification number | KM05995721 | Number of Individuals Covered | 106 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $6,672 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $111,635 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,672 | Insurance broker organization code? | 3 | Insurance broker name | OWEN-DUNN INSURANCE SERVICES |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 660527 |
Policy instance | 1 |
Insurance contract or identification number | 660527 | Number of Individuals Covered | 38 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $22,196 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $343,687 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,196 | Insurance broker organization code? | 3 | Insurance broker name | OWEN-DUNN INSURANCE SERVICES |
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