BOARD OF TRUSTEES, CALIFORNIA ENTERTAINMENT INDUSTRY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CALIFORNIA ENTERTAINMENT INDUSTRY TRUST
| Measure | Date | Value |
|---|
| 2018 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2018 401k financial data |
|---|
| Total transfer of assets from this plan | 2018-12-31 | $357,759 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $53,157 |
| Total income from all sources (including contributions) | 2018-12-31 | $686,814 |
| Total of all expenses incurred | 2018-12-31 | $915,619 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $673,574 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $686,814 |
| Value of total assets at end of year | 2018-12-31 | $0 |
| Value of total assets at beginning of year | 2018-12-31 | $639,721 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $242,045 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2018-12-31 | $0 |
| Administrative expenses professional fees incurred | 2018-12-31 | $71,236 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $50,057 |
| Administrative expenses (other) incurred | 2018-12-31 | $101,965 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $3,100 |
| Total non interest bearing cash at end of year | 2018-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $636,899 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-228,805 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $586,564 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $673,574 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $686,814 |
| Contract administrator fees | 2018-12-31 | $68,844 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-12-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-12-31 | $2,822 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2018-12-31 | 952036255 |
| 2017 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $53,157 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $49,827 |
| Total income from all sources (including contributions) | 2017-12-31 | $791,459 |
| Total of all expenses incurred | 2017-12-31 | $929,625 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $730,137 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $791,459 |
| Value of total assets at end of year | 2017-12-31 | $639,721 |
| Value of total assets at beginning of year | 2017-12-31 | $774,557 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $199,488 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $32,550 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $2,439 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $6,558 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $50,057 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $40,851 |
| Administrative expenses (other) incurred | 2017-12-31 | $118,903 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $3,100 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $8,976 |
| Total non interest bearing cash at end of year | 2017-12-31 | $636,899 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $765,554 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $-138,166 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $586,564 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $724,730 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $730,137 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $789,020 |
| Contract administrator fees | 2017-12-31 | $48,035 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2017-12-31 | $2,822 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2017-12-31 | $2,445 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2017-12-31 | 952036255 |
| 2016 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $49,827 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $354,220 |
| Total income from all sources (including contributions) | 2016-12-31 | $3,299,361 |
| Total of all expenses incurred | 2016-12-31 | $3,190,839 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $2,809,672 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $3,299,361 |
| Value of total assets at end of year | 2016-12-31 | $774,557 |
| Value of total assets at beginning of year | 2016-12-31 | $970,428 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $381,167 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $38,154 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $54,535 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $6,558 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-12-31 | $40,851 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $301,505 |
| Administrative expenses (other) incurred | 2016-12-31 | $194,887 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $8,976 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $4,643 |
| Total non interest bearing cash at end of year | 2016-12-31 | $765,554 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $967,817 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $108,522 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $724,730 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $616,208 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $2,809,672 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $3,244,826 |
| Contract administrator fees | 2016-12-31 | $148,126 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $48,072 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2016-12-31 | $2,445 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-12-31 | $2,611 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2016-12-31 | 952036255 |
| 2015 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $354,220 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $349,311 |
| Total income from all sources (including contributions) | 2015-12-31 | $4,005,778 |
| Total of all expenses incurred | 2015-12-31 | $3,976,915 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $3,530,176 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $4,005,778 |
| Value of total assets at end of year | 2015-12-31 | $970,428 |
| Value of total assets at beginning of year | 2015-12-31 | $936,656 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $446,739 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $17,570 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $107,113 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $301,505 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $340,518 |
| Administrative expenses (other) incurred | 2015-12-31 | $245,557 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $4,643 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $1,250 |
| Total non interest bearing cash at end of year | 2015-12-31 | $967,817 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $933,878 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $28,863 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $616,208 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $587,345 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $3,530,176 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $3,898,665 |
| Contract administrator fees | 2015-12-31 | $183,612 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $48,072 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $7,543 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-12-31 | $2,611 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2015-12-31 | $2,778 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2015-12-31 | 952036255 |
| 2014 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $349,311 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $414,006 |
| Total income from all sources (including contributions) | 2014-12-31 | $4,174,488 |
| Total of all expenses incurred | 2014-12-31 | $4,073,582 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $3,605,541 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $4,174,488 |
| Value of total assets at end of year | 2014-12-31 | $936,656 |
| Value of total assets at beginning of year | 2014-12-31 | $900,445 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $468,041 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $22,604 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $215,060 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $5,306 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $340,518 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $372,067 |
| Administrative expenses (other) incurred | 2014-12-31 | $226,548 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $1,250 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $4,253 |
| Total non interest bearing cash at end of year | 2014-12-31 | $933,878 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $895,139 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $100,906 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $587,345 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $486,439 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $3,605,541 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $3,959,428 |
| Contract administrator fees | 2014-12-31 | $218,889 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $7,543 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $37,686 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2014-12-31 | $2,778 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2014-12-31 | $0 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2014-12-31 | 952036255 |
| 2013 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $414,006 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $302,939 |
| Total income from all sources (including contributions) | 2013-12-31 | $3,890,352 |
| Total of all expenses incurred | 2013-12-31 | $3,886,248 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $3,405,675 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $3,890,352 |
| Value of total assets at end of year | 2013-12-31 | $900,445 |
| Value of total assets at beginning of year | 2013-12-31 | $785,274 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $480,573 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $30,292 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $183,818 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $5,306 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $5,436 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $372,067 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $293,801 |
| Administrative expenses (other) incurred | 2013-12-31 | $224,564 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $4,253 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $2,414 |
| Total non interest bearing cash at end of year | 2013-12-31 | $895,139 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $779,838 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $4,104 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $486,439 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $482,335 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $3,405,675 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $3,706,534 |
| Contract administrator fees | 2013-12-31 | $225,717 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $37,686 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $6,724 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2013-12-31 | 952036255 |
| 2012 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $302,939 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $236,823 |
| Total income from all sources (including contributions) | 2012-12-31 | $3,447,426 |
| Total of all expenses incurred | 2012-12-31 | $3,402,891 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $3,005,387 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $3,447,426 |
| Value of total assets at end of year | 2012-12-31 | $785,274 |
| Value of total assets at beginning of year | 2012-12-31 | $674,623 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $397,504 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $109,504 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $127,430 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $5,436 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $2,770 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $293,801 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $236,194 |
| Administrative expenses (other) incurred | 2012-12-31 | $104,767 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $2,414 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $629 |
| Total non interest bearing cash at end of year | 2012-12-31 | $779,838 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $671,853 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $44,535 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $482,335 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $437,800 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $3,005,387 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $3,319,996 |
| Contract administrator fees | 2012-12-31 | $183,233 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $6,724 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $0 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2012-12-31 | 952036255 |
| 2011 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $236,823 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $218,343 |
| Total income from all sources (including contributions) | 2011-12-31 | $3,129,744 |
| Total of all expenses incurred | 2011-12-31 | $3,081,902 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $2,716,987 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $3,129,680 |
| Value of total assets at end of year | 2011-12-31 | $674,623 |
| Value of total assets at beginning of year | 2011-12-31 | $608,301 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $364,915 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $84,256 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $178,906 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $2,770 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $56,518 |
| Other income not declared elsewhere | 2011-12-31 | $64 |
| Administrative expenses (other) incurred | 2011-12-31 | $96,426 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $629 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $4,558 |
| Total non interest bearing cash at end of year | 2011-12-31 | $671,853 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $551,783 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $47,842 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $437,800 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $389,958 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $2,716,987 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $2,950,774 |
| Contract administrator fees | 2011-12-31 | $184,233 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Liabilities. Value of acquisition indebtedness at end of year | 2011-12-31 | $236,194 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2011-12-31 | $213,785 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | MILLER, KAPLAN, ARASE & CO., LLP |
| Accountancy firm EIN | 2011-12-31 | 952036255 |
| 2010 : CALIFORNIA ENTERTAINMENT INDUSTRY TRUST 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $218,343 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $331,947 |
| Total income from all sources (including contributions) | 2010-12-31 | $3,438,978 |
| Total of all expenses incurred | 2010-12-31 | $3,365,254 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $2,990,853 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $3,438,978 |
| Value of total assets at end of year | 2010-12-31 | $608,301 |
| Value of total assets at beginning of year | 2010-12-31 | $648,181 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $374,401 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $18,529 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $1,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $56,518 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $156,274 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $213,785 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $254,290 |
| Administrative expenses (other) incurred | 2010-12-31 | $242,818 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $4,558 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $77,657 |
| Total non interest bearing cash at end of year | 2010-12-31 | $551,783 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $491,907 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $73,724 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $389,958 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $316,234 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $2,990,853 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $3,438,978 |
| Contract administrator fees | 2010-12-31 | $113,054 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | JOHNSON, FUJITA, PEAUROI, ACCT CORP |
| Accountancy firm EIN | 2010-12-31 | 953052675 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 5 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 4 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $772 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $7,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $772 | | Insurance broker organization code? | 4 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 33 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 47 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231330 |
| Policy instance | 1 |
| Insurance contract or identification number | 231330 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $89,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0054123 |
| Policy instance | 6 |
| Insurance contract or identification number | W0054123 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $548,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231330 |
| Policy instance | 1 |
| Insurance contract or identification number | 231330 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $235,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Total amount of commissions paid to insurance broker | USD $2,498 | | Total amount of fees paid to insurance company | USD $257 | | 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 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 | | 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 | | Commission paid to Insurance Broker | USD $2,498 | | Amount paid for insurance broker fees | 257 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 63 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,796 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 52 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,414 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 5 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,929 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 4 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,030 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $8,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,030 | | Insurance broker organization code? | 4 | | Insurance broker name | THE PLANNING CORPORATION |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0054123 |
| Policy instance | 6 |
| Insurance contract or identification number | W0054123 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $578,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker name | THE PLANNING CORPORATION |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 286 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231330 |
| Policy instance | 1 |
| Insurance contract or identification number | 231330 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $439,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Total amount of commissions paid to insurance broker | USD $2,058 | | Total amount of fees paid to insurance company | USD $124 | | 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 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 | | 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 | | Other welfare benefits provided | WELLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $2,058 | | Amount paid for insurance broker fees | 124 | | Additional information about fees paid to insurance broker | BONUS AND NON-MONETARY | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 291 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 4 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 419 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,192 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $31,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,192 | | Insurance broker name | THE PLANNING CORPORATION |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 5 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 240897 |
| Policy instance | 6 |
| Insurance contract or identification number | 240897 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $346,671 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0902445 |
| Policy instance | 7 |
| Insurance contract or identification number | 0902445 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,026,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0054123 |
| Policy instance | 8 |
| Insurance contract or identification number | W0054123 | | Number of Individuals Covered | 518 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,548,582 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 3 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0712426 |
| Policy instance | 7 |
| Insurance contract or identification number | 0712426 | | Number of Individuals Covered | 359 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,032,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 6 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 425 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,850 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $38,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,850 | | Insurance broker name | THE PLANNING CORPORATION |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231330 |
| Policy instance | 5 |
| Insurance contract or identification number | 231330 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $391,033 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 4 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 395 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 240897, 243737 |
| Policy instance | 2 |
| Insurance contract or identification number | 240897, 243737 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $947,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 1 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 308 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 283 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 243737 |
| Policy instance | 1 |
| Insurance contract or identification number | 243737 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,047,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 334 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0712426 |
| Policy instance | 4 |
| Insurance contract or identification number | 0712426 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,861,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231330 |
| Policy instance | 5 |
| Insurance contract or identification number | 231330 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $186,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 6 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 7 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 650 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,860 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $38,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,860 | | Insurance broker name | THE PLANNING CORPORATION |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 3 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,678 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $36,782 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,678 | | Insurance broker name | THE PLANNING CORPORATION |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 2 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 6 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 217 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0712426 |
| Policy instance | 7 |
| Insurance contract or identification number | 0712426 | | Number of Individuals Covered | 359 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,659,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 240897/243737 |
| Policy instance | 1 |
| Insurance contract or identification number | 240897/243737 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,086,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 6 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 297 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,796 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231330 |
| Policy instance | 5 |
| Insurance contract or identification number | 231330 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 4 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 217 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 3 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 240897/243737 |
| Policy instance | 2 |
| Insurance contract or identification number | 240897/243737 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,086,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 7 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 297 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,796 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 1 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,678 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $36,782 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0712426 |
| Policy instance | 4 |
| Insurance contract or identification number | 0712426 | | Number of Individuals Covered | 359 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,659,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0712426 |
| Policy instance | 6 |
| Insurance contract or identification number | 0712426 | | Number of Individuals Covered | 359 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,497,266 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH621W*000 |
| Policy instance | 4 |
| Insurance contract or identification number | LH621W*000 | | Number of Individuals Covered | 517 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,676 | | Other welfare benefits provided | CHIROPRACTIC AND ACUPUNCTURE | | Welfare Benefit Premiums Paid to Carrier | USD $36,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 850111 |
| Policy instance | 1 |
| Insurance contract or identification number | 850111 | | Number of Individuals Covered | 345 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 298-003 |
| Policy instance | 2 |
| Insurance contract or identification number | 298-003 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 850112 |
| Policy instance | 3 |
| Insurance contract or identification number | 850112 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 240897/243737 |
| Policy instance | 5 |
| Insurance contract or identification number | 240897/243737 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,086,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 443 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $40,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MES VISION (National Association of Insurance Commissioners NAIC id number: 62111 ) |
| Policy contract number | M4AD-D |
| Policy instance | 3 |
| Insurance contract or identification number | M4AD-D | | Number of Individuals Covered | 304 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 240897 |
| Policy instance | 2 |
| Insurance contract or identification number | 240897 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,009,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF OHIO (National Association of Insurance Commissioners NAIC id number: 95186 ) |
| Policy contract number | 404525 |
| Policy instance | 1 |
| Insurance contract or identification number | 404525 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,748,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 850111 |
| Policy instance | 5 |
| Insurance contract or identification number | 850111 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $160,509 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
