ERM GROUP, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE ERM GROUP HEALTH & WELFARE PLAN
| Measure | Date | Value |
|---|
| 2019 : THE ERM GROUP HEALTH & WELFARE PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $2,492,008 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $3,097,878 |
| Total income from all sources (including contributions) | 2019-12-31 | $29,217,705 |
| Total of all expenses incurred | 2019-12-31 | $28,981,946 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $27,874,745 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $29,198,274 |
| Value of total assets at end of year | 2019-12-31 | $2,681,362 |
| Value of total assets at beginning of year | 2019-12-31 | $3,051,473 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,107,201 |
| Total interest from all sources | 2019-12-31 | $19,431 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $229,401 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $1,138,126 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $387,253 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $1,535,329 |
| Total non interest bearing cash at end of year | 2019-12-31 | $576,607 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $432,461 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $235,759 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $189,354 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-46,405 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2019-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $19,431 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $5,764,395 |
| Asset value of US Government securities at end of year | 2019-12-31 | $1,491 |
| Asset value of US Government securities at beginning of year | 2019-12-31 | $1,158,712 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $27,830,747 |
| Employer contributions (assets) at end of year | 2019-12-31 | $2,103,264 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $1,460,300 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $22,110,350 |
| Contract administrator fees | 2019-12-31 | $1,107,201 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $2,104,755 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $1,562,549 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| 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 | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
| Accountancy firm name | 2019-12-31 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2019-12-31 | 232334403 |
| 2018 : THE ERM GROUP HEALTH & WELFARE PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $3,097,878 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $2,207,848 |
| Total income from all sources (including contributions) | 2018-12-31 | $11,643,011 |
| Total of all expenses incurred | 2018-12-31 | $11,662,365 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $11,272,012 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $11,636,144 |
| Value of total assets at end of year | 2018-12-31 | $3,051,473 |
| Value of total assets at beginning of year | 2018-12-31 | $2,180,797 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $390,353 |
| Total interest from all sources | 2018-12-31 | $6,867 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $90,928 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $135,793 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $1,535,329 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $353,606 |
| Total non interest bearing cash at end of year | 2018-12-31 | $432,461 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $326,555 |
| 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 | $-19,354 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $-46,405 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-27,051 |
| 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 |
| Value of interest in pooled separate accounts at end of year | 2018-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $6,867 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $2,420,894 |
| Asset value of US Government securities at end of year | 2018-12-31 | $1,158,712 |
| Asset value of US Government securities at beginning of year | 2018-12-31 | $989,288 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
| 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 | $11,409,423 |
| Employer contributions (assets) at end of year | 2018-12-31 | $1,460,300 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $864,954 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $8,851,118 |
| Contract administrator fees | 2018-12-31 | $390,353 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $1,562,549 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $1,854,242 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| 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 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Disclaimer |
| Accountancy firm name | 2018-12-31 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2018-12-31 | 232334403 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $2,207,848 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $2,549,030 |
| Total income from all sources (including contributions) | 2018-06-30 | $24,194,475 |
| Total of all expenses incurred | 2018-06-30 | $24,332,487 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-06-30 | $23,149,918 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-06-30 | $24,182,611 |
| Value of total assets at end of year | 2018-06-30 | $2,180,797 |
| Value of total assets at beginning of year | 2018-06-30 | $2,659,991 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-06-30 | $1,182,569 |
| Total interest from all sources | 2018-06-30 | $11,864 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-06-30 | No |
| Was this plan covered by a fidelity bond | 2018-06-30 | Yes |
| Value of fidelity bond cover | 2018-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2018-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-06-30 | No |
| Contributions received from participants | 2018-06-30 | $264,325 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-06-30 | $315,222 |
| Liabilities. Value of operating payables at end of year | 2018-06-30 | $353,606 |
| Liabilities. Value of operating payables at beginning of year | 2018-06-30 | $158,334 |
| Total non interest bearing cash at end of year | 2018-06-30 | $326,555 |
| Total non interest bearing cash at beginning of year | 2018-06-30 | $269,295 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Value of net income/loss | 2018-06-30 | $-138,012 |
| Value of net assets at end of year (total assets less liabilities) | 2018-06-30 | $-27,051 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-06-30 | $110,961 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-06-30 | No |
| Value of interest in common/collective trusts at end of year | 2018-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-06-30 | $11,864 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-06-30 | $3,447,312 |
| Asset value of US Government securities at end of year | 2018-06-30 | $989,288 |
| Asset value of US Government securities at beginning of year | 2018-06-30 | $982,350 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-06-30 | No |
| Contributions received in cash from employer | 2018-06-30 | $23,603,064 |
| Employer contributions (assets) at end of year | 2018-06-30 | $864,954 |
| Employer contributions (assets) at beginning of year | 2018-06-30 | $1,408,346 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-06-30 | $19,702,606 |
| Contract administrator fees | 2018-06-30 | $1,182,569 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-06-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-06-30 | $1,854,242 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-06-30 | $2,390,696 |
| Did the plan have assets held for investment | 2018-06-30 | Yes |
| 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 | 2018-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-06-30 | Disclaimer |
| Accountancy firm name | 2018-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2018-06-30 | 232334403 |
| 2017 : THE ERM GROUP HEALTH & WELFARE PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $2,549,030 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $2,128,926 |
| Total income from all sources (including contributions) | 2017-06-30 | $24,648,625 |
| Total of all expenses incurred | 2017-06-30 | $24,605,408 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-06-30 | $23,163,463 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-06-30 | $24,647,048 |
| Value of total assets at end of year | 2017-06-30 | $2,659,991 |
| Value of total assets at beginning of year | 2017-06-30 | $2,196,670 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-06-30 | $1,441,945 |
| Total interest from all sources | 2017-06-30 | $1,577 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-06-30 | No |
| Was this plan covered by a fidelity bond | 2017-06-30 | Yes |
| Value of fidelity bond cover | 2017-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2017-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-06-30 | No |
| Contributions received from participants | 2017-06-30 | $463,654 |
| Liabilities. Value of operating payables at end of year | 2017-06-30 | $158,334 |
| Liabilities. Value of operating payables at beginning of year | 2017-06-30 | $309,073 |
| Total non interest bearing cash at end of year | 2017-06-30 | $269,295 |
| Total non interest bearing cash at beginning of year | 2017-06-30 | $376,818 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Value of net income/loss | 2017-06-30 | $43,217 |
| Value of net assets at end of year (total assets less liabilities) | 2017-06-30 | $110,961 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-06-30 | $67,744 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-06-30 | No |
| Value of interest in common/collective trusts at end of year | 2017-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-06-30 | $1,577 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-06-30 | $2,426,972 |
| Asset value of US Government securities at end of year | 2017-06-30 | $982,350 |
| Asset value of US Government securities at beginning of year | 2017-06-30 | $534,078 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-06-30 | No |
| Contributions received in cash from employer | 2017-06-30 | $24,183,394 |
| Employer contributions (assets) at end of year | 2017-06-30 | $1,408,346 |
| Employer contributions (assets) at beginning of year | 2017-06-30 | $1,285,774 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-06-30 | $20,736,491 |
| Contract administrator fees | 2017-06-30 | $1,441,945 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-06-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-06-30 | $2,390,696 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-06-30 | $1,819,853 |
| Did the plan have assets held for investment | 2017-06-30 | Yes |
| 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 | 2017-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-06-30 | Disclaimer |
| Accountancy firm name | 2017-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2017-06-30 | 232334403 |
| 2016 : THE ERM GROUP HEALTH & WELFARE PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $2,128,926 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $2,216,801 |
| Total income from all sources (including contributions) | 2016-06-30 | $23,649,491 |
| Total of all expenses incurred | 2016-06-30 | $24,197,208 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-06-30 | $22,641,198 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-06-30 | $23,649,227 |
| Value of total assets at end of year | 2016-06-30 | $2,196,670 |
| Value of total assets at beginning of year | 2016-06-30 | $2,832,262 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-06-30 | $1,556,010 |
| Total interest from all sources | 2016-06-30 | $149 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-06-30 | No |
| Was this plan covered by a fidelity bond | 2016-06-30 | Yes |
| Value of fidelity bond cover | 2016-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2016-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-06-30 | No |
| Contributions received from participants | 2016-06-30 | $392,499 |
| Other income not declared elsewhere | 2016-06-30 | $115 |
| Liabilities. Value of operating payables at end of year | 2016-06-30 | $309,073 |
| Liabilities. Value of operating payables at beginning of year | 2016-06-30 | $874,693 |
| Total non interest bearing cash at end of year | 2016-06-30 | $376,818 |
| Total non interest bearing cash at beginning of year | 2016-06-30 | $317,193 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Value of net income/loss | 2016-06-30 | $-547,717 |
| Value of net assets at end of year (total assets less liabilities) | 2016-06-30 | $67,744 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-06-30 | $615,461 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-06-30 | No |
| Value of interest in common/collective trusts at end of year | 2016-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-06-30 | $149 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-06-30 | $2,697,882 |
| Asset value of US Government securities at end of year | 2016-06-30 | $534,078 |
| Asset value of US Government securities at beginning of year | 2016-06-30 | $219,141 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-06-30 | No |
| Contributions received in cash from employer | 2016-06-30 | $23,256,728 |
| Employer contributions (assets) at end of year | 2016-06-30 | $1,285,774 |
| Employer contributions (assets) at beginning of year | 2016-06-30 | $2,295,928 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-06-30 | $19,943,316 |
| Contract administrator fees | 2016-06-30 | $1,556,010 |
| Liabilities. Value of benefit claims payable at end of year | 2016-06-30 | $1,819,853 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-06-30 | $1,342,108 |
| Did the plan have assets held for investment | 2016-06-30 | Yes |
| 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 | 2016-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-06-30 | Disclaimer |
| Accountancy firm name | 2016-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2016-06-30 | 232334403 |
| 2015 : THE ERM GROUP HEALTH & WELFARE PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $2,216,801 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $1,467,403 |
| Total income from all sources (including contributions) | 2015-06-30 | $22,503,523 |
| Total of all expenses incurred | 2015-06-30 | $23,060,228 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-06-30 | $21,479,922 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-06-30 | $22,503,328 |
| Value of total assets at end of year | 2015-06-30 | $2,832,262 |
| Value of total assets at beginning of year | 2015-06-30 | $2,639,569 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-06-30 | $1,580,306 |
| Total interest from all sources | 2015-06-30 | $195 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-06-30 | No |
| Was this plan covered by a fidelity bond | 2015-06-30 | Yes |
| Value of fidelity bond cover | 2015-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2015-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-06-30 | No |
| Contributions received from participants | 2015-06-30 | $179,217 |
| Assets. Other investments not covered elsewhere at beginning of year | 2015-06-30 | $17,653 |
| Liabilities. Value of operating payables at end of year | 2015-06-30 | $874,693 |
| Total non interest bearing cash at end of year | 2015-06-30 | $317,193 |
| Total non interest bearing cash at beginning of year | 2015-06-30 | $125,679 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Value of net income/loss | 2015-06-30 | $-556,705 |
| Value of net assets at end of year (total assets less liabilities) | 2015-06-30 | $615,461 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-06-30 | $1,172,166 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-06-30 | No |
| Value of interest in common/collective trusts at end of year | 2015-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-06-30 | $195 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-06-30 | $3,029,154 |
| Asset value of US Government securities at end of year | 2015-06-30 | $219,141 |
| Asset value of US Government securities at beginning of year | 2015-06-30 | $1,406,588 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-06-30 | No |
| Contributions received in cash from employer | 2015-06-30 | $22,324,111 |
| Employer contributions (assets) at end of year | 2015-06-30 | $2,295,928 |
| Employer contributions (assets) at beginning of year | 2015-06-30 | $1,089,649 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-06-30 | $18,450,768 |
| Contract administrator fees | 2015-06-30 | $1,580,306 |
| Liabilities. Value of benefit claims payable at end of year | 2015-06-30 | $1,342,108 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-06-30 | $1,467,403 |
| Did the plan have assets held for investment | 2015-06-30 | Yes |
| 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 | 2015-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-06-30 | Disclaimer |
| Accountancy firm name | 2015-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2015-06-30 | 232334403 |
| 2014 : THE ERM GROUP HEALTH & WELFARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $1,467,403 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $1,893,519 |
| Total income from all sources (including contributions) | 2014-06-30 | $23,057,142 |
| Total of all expenses incurred | 2014-06-30 | $22,000,073 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-06-30 | $20,812,236 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-06-30 | $23,057,015 |
| Value of total assets at end of year | 2014-06-30 | $2,639,569 |
| Value of total assets at beginning of year | 2014-06-30 | $2,008,616 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-06-30 | $1,187,837 |
| Total interest from all sources | 2014-06-30 | $127 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-06-30 | No |
| Was this plan covered by a fidelity bond | 2014-06-30 | Yes |
| Value of fidelity bond cover | 2014-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2014-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-06-30 | No |
| Contributions received from participants | 2014-06-30 | $367,422 |
| Assets. Other investments not covered elsewhere at end of year | 2014-06-30 | $17,653 |
| Total non interest bearing cash at end of year | 2014-06-30 | $125,679 |
| Total non interest bearing cash at beginning of year | 2014-06-30 | $94,309 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Value of net income/loss | 2014-06-30 | $1,057,069 |
| Value of net assets at end of year (total assets less liabilities) | 2014-06-30 | $1,172,166 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-06-30 | $115,097 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-06-30 | No |
| Value of interest in common/collective trusts at end of year | 2014-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-06-30 | $127 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-06-30 | $3,150,363 |
| Asset value of US Government securities at end of year | 2014-06-30 | $1,406,588 |
| Asset value of US Government securities at beginning of year | 2014-06-30 | $488,395 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-06-30 | No |
| Contributions received in cash from employer | 2014-06-30 | $22,689,593 |
| Employer contributions (assets) at end of year | 2014-06-30 | $1,089,649 |
| Employer contributions (assets) at beginning of year | 2014-06-30 | $1,425,912 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-06-30 | $17,661,873 |
| Contract administrator fees | 2014-06-30 | $1,187,837 |
| Liabilities. Value of benefit claims payable at end of year | 2014-06-30 | $1,467,403 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-06-30 | $1,893,519 |
| Did the plan have assets held for investment | 2014-06-30 | Yes |
| 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 | 2014-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-06-30 | Disclaimer |
| Accountancy firm name | 2014-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2014-06-30 | 232334403 |
| 2013 : THE ERM GROUP HEALTH & WELFARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $1,893,519 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $1,645,655 |
| Total income from all sources (including contributions) | 2013-06-30 | $21,774,106 |
| Total of all expenses incurred | 2013-06-30 | $21,805,747 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-06-30 | $20,656,893 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-06-30 | $21,773,991 |
| Value of total assets at end of year | 2013-06-30 | $2,008,616 |
| Value of total assets at beginning of year | 2013-06-30 | $1,792,393 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-06-30 | $1,148,854 |
| Total interest from all sources | 2013-06-30 | $115 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-06-30 | No |
| Was this plan covered by a fidelity bond | 2013-06-30 | Yes |
| Value of fidelity bond cover | 2013-06-30 | $1,250,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-06-30 | No |
| Contributions received from participants | 2013-06-30 | $268,933 |
| Liabilities. Value of operating payables at beginning of year | 2013-06-30 | $126,621 |
| Total non interest bearing cash at end of year | 2013-06-30 | $94,309 |
| Total non interest bearing cash at beginning of year | 2013-06-30 | $124,385 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Value of net income/loss | 2013-06-30 | $-31,641 |
| Value of net assets at end of year (total assets less liabilities) | 2013-06-30 | $115,097 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-06-30 | $146,738 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-06-30 | No |
| Value of interest in common/collective trusts at end of year | 2013-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-06-30 | $115 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-06-30 | $3,018,265 |
| Asset value of US Government securities at end of year | 2013-06-30 | $488,395 |
| Asset value of US Government securities at beginning of year | 2013-06-30 | $496,338 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-06-30 | No |
| Contributions received in cash from employer | 2013-06-30 | $21,505,058 |
| Employer contributions (assets) at end of year | 2013-06-30 | $1,425,912 |
| Employer contributions (assets) at beginning of year | 2013-06-30 | $1,171,670 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-06-30 | $17,638,628 |
| Contract administrator fees | 2013-06-30 | $1,148,854 |
| Liabilities. Value of benefit claims payable at end of year | 2013-06-30 | $1,893,519 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-06-30 | $1,519,034 |
| Did the plan have assets held for investment | 2013-06-30 | Yes |
| 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 | 2013-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2013-06-30 | Disclaimer |
| Accountancy firm name | 2013-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2013-06-30 | 232334403 |
| 2012 : THE ERM GROUP HEALTH & WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $1,645,655 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $2,319,872 |
| Total income from all sources (including contributions) | 2012-06-30 | $17,024,378 |
| Total of all expenses incurred | 2012-06-30 | $17,100,477 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $16,035,316 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $17,024,158 |
| Value of total assets at end of year | 2012-06-30 | $1,792,393 |
| Value of total assets at beginning of year | 2012-06-30 | $2,542,709 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $1,065,161 |
| Total interest from all sources | 2012-06-30 | $220 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Was this plan covered by a fidelity bond | 2012-06-30 | Yes |
| Value of fidelity bond cover | 2012-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2012-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Contributions received from participants | 2012-06-30 | $234,291 |
| Participant contributions at end of year | 2012-06-30 | $1,171,670 |
| Participant contributions at beginning of year | 2012-06-30 | $7,632 |
| Liabilities. Value of operating payables at end of year | 2012-06-30 | $126,621 |
| Liabilities. Value of operating payables at beginning of year | 2012-06-30 | $1,443,936 |
| Total non interest bearing cash at end of year | 2012-06-30 | $124,385 |
| Total non interest bearing cash at beginning of year | 2012-06-30 | $98,405 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $-76,099 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $146,738 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $222,837 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-06-30 | $220 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-06-30 | $2,583,533 |
| Asset value of US Government securities at end of year | 2012-06-30 | $496,338 |
| Asset value of US Government securities at beginning of year | 2012-06-30 | $2,436,672 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $16,789,867 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-06-30 | $13,451,783 |
| Contract administrator fees | 2012-06-30 | $1,065,161 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-06-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-06-30 | $1,519,034 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-06-30 | $875,936 |
| Did the plan have assets held for investment | 2012-06-30 | Yes |
| 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 | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Disclaimer |
| Accountancy firm name | 2012-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2012-06-30 | 232334403 |
| 2011 : THE ERM GROUP HEALTH & WELFARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $2,319,872 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $959,318 |
| Total income from all sources (including contributions) | 2011-06-30 | $13,292,310 |
| Total of all expenses incurred | 2011-06-30 | $13,188,795 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $12,317,195 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $13,292,182 |
| Value of total assets at end of year | 2011-06-30 | $2,542,709 |
| Value of total assets at beginning of year | 2011-06-30 | $1,078,640 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $871,600 |
| Total interest from all sources | 2011-06-30 | $128 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Was this plan covered by a fidelity bond | 2011-06-30 | Yes |
| Value of fidelity bond cover | 2011-06-30 | $1,250,000 |
| If this is an individual account plan, was there a blackout period | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $225,272 |
| Participant contributions at end of year | 2011-06-30 | $7,632 |
| Liabilities. Value of operating payables at end of year | 2011-06-30 | $1,443,936 |
| Total non interest bearing cash at end of year | 2011-06-30 | $98,405 |
| Total non interest bearing cash at beginning of year | 2011-06-30 | $50,594 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $103,515 |
| Value of net assets at end of year (total assets less liabilities) | 2011-06-30 | $222,837 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $119,322 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-06-30 | $128 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $2,249,797 |
| Asset value of US Government securities at end of year | 2011-06-30 | $2,436,672 |
| Asset value of US Government securities at beginning of year | 2011-06-30 | $744,766 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $13,066,910 |
| Employer contributions (assets) at beginning of year | 2011-06-30 | $283,280 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-06-30 | $10,067,398 |
| Contract administrator fees | 2011-06-30 | $871,600 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-06-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-06-30 | $875,936 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-06-30 | $959,318 |
| Did the plan have assets held for investment | 2011-06-30 | Yes |
| 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 | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Disclaimer |
| Accountancy firm name | 2011-06-30 | ARENA SNYDER & DUNLAP LLP |
| Accountancy firm EIN | 2011-06-30 | 232334403 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 233612 |
| Policy instance | 1 |
| Insurance contract or identification number | 233612 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 281962 |
| Policy instance | 8 |
| Insurance contract or identification number | 281962 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $481 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 481 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE |
|
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
| Policy contract number | DBL 252424 |
| Policy instance | 7 |
| Insurance contract or identification number | DBL 252424 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | DISABILITY BENEFIT LAW | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 125066 |
| Policy instance | 6 |
| Insurance contract or identification number | LTD 125066 | | Number of Individuals Covered | 1836 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $325 | | Total amount of fees paid to insurance company | USD $8,183 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $325 | | Amount paid for insurance broker fees | 8183 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10024111001 |
| Policy instance | 10 |
| Insurance contract or identification number | 10024111001 | | Number of Individuals Covered | 1468 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153839 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 153839 | | Number of Individuals Covered | 1836 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,616 | | Total amount of fees paid to insurance company | USD $8,242 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,616 | | Amount paid for insurance broker fees | 8242 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153817 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 153817 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,736 | | Total amount of fees paid to insurance company | USD $6,076 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,736 | | Amount paid for insurance broker fees | 6076 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10029851001 |
| Policy instance | 11 |
| Insurance contract or identification number | 10029851001 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL34020 |
| Policy instance | 13 |
| Insurance contract or identification number | HCL34020 | | Number of Individuals Covered | 1601 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $29,607 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,607 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10029861001 |
| Policy instance | 12 |
| Insurance contract or identification number | 10029861001 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10024101001 |
| Policy instance | 9 |
| Insurance contract or identification number | 10024101001 | | Number of Individuals Covered | 2125 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | 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 | 48311 |
| Policy instance | 2 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206540 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR 206540 | | Number of Individuals Covered | 798 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $750 | | Total amount of fees paid to insurance company | USD $1,718 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $750 | | Amount paid for insurance broker fees | 1718 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153817 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 153817 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $13,655 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,655 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10029861001 |
| Policy instance | 11 |
| Insurance contract or identification number | 10029861001 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 9473237 |
| Policy instance | 12 |
| Insurance contract or identification number | 9473237 | | Number of Individuals Covered | 1424 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $229,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $167,736 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 233612 |
| Policy instance | 1 |
| Insurance contract or identification number | 233612 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $5,000 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5000 | | Additional information about fees paid to insurance broker | SERVICE FEES |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10024101001 |
| Policy instance | 8 |
| Insurance contract or identification number | 10024101001 | | Number of Individuals Covered | 1811 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 610168 |
| Policy instance | 7 |
| Insurance contract or identification number | G 610168 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $124 | | Other welfare benefits provided | WEEKLY INCOME | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $124 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 125066 |
| Policy instance | 6 |
| Insurance contract or identification number | LTD 125066 | | Number of Individuals Covered | 1739 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,605 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,605 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206540 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR 206540 | | Number of Individuals Covered | 815 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,787 | | 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 $3,787 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 48311 |
| Policy instance | 2 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10029851001 |
| Policy instance | 10 |
| Insurance contract or identification number | 10029851001 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10024111001 |
| Policy instance | 9 |
| Insurance contract or identification number | 10024111001 | | Number of Individuals Covered | 1433 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153839 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 153839 | | Number of Individuals Covered | 1739 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $22,485 | | Life Insurance Welfare Benefit | Yes | | 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 $22,485 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10024111001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10024111001 | | Number of Individuals Covered | 1413 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | 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 | 3003 |
| Policy instance | 12 |
| Insurance contract or identification number | 3003 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 610168 |
| Policy instance | 11 |
| Insurance contract or identification number | G 610168 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $197 | | Total amount of fees paid to insurance company | USD $37 | | Other welfare benefits provided | WEEKLY INCOME | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10029861001 |
| Policy instance | 10 |
| Insurance contract or identification number | 10029861001 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-2798 |
| Policy instance | 1 |
| Insurance contract or identification number | 947-2798 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $200,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10029851001 |
| Policy instance | 9 |
| Insurance contract or identification number | 10029851001 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 125066 |
| Policy instance | 8 |
| Insurance contract or identification number | LTD 125066 | | Number of Individuals Covered | 1673 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $6,230 | | Total amount of fees paid to insurance company | USD $6,566 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153839 |
| Policy instance | 6 |
| Insurance contract or identification number | GL 153839 | | Number of Individuals Covered | 1673 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $37,203 | | Total amount of fees paid to insurance company | USD $7,319 | | Life Insurance Welfare Benefit | Yes | | 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 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153817 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 153817 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $33,088 | | Total amount of fees paid to insurance company | USD $6,715 | | Life Insurance Welfare Benefit | Yes | | 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 | 48311 |
| Policy instance | 4 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10024101001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10024101001 | | Number of Individuals Covered | 1600 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206540 |
| Policy instance | 7 |
| Insurance contract or identification number | VAR 206540 | | Number of Individuals Covered | 757 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $9,148 | | Total amount of fees paid to insurance company | USD $1,760 | | 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 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-2467 |
| Policy instance | 2 |
| Insurance contract or identification number | 947-2467 | | Number of Individuals Covered | 1514 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $34,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,850 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 191510 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 191510 S001 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,119 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,119 | | Insurance broker name | ROGUS, EVE |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 48311 |
| Policy instance | 3 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | 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 | 3003 |
| Policy instance | 4 |
| Insurance contract or identification number | 3003 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153817 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 153817 | | Number of Individuals Covered | 283 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-12-01 | | Total amount of commissions paid to insurance broker | USD $21,491 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,491 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153817 |
| Policy instance | 6 |
| Insurance contract or identification number | GL 153817 | | Number of Individuals Covered | 401 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $29,621 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,621 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153839 |
| Policy instance | 7 |
| Insurance contract or identification number | GL 153839 | | Number of Individuals Covered | 1883 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $40,954 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,954 | | Insurance broker name | MARSH & MCLENNAN |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 125066 |
| Policy instance | 8 |
| Insurance contract or identification number | LTD 125066 | | Number of Individuals Covered | 1888 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $6,651 | | Total amount of fees paid to insurance company | USD $9,679 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,651 | | Amount paid for insurance broker fees | 9679 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206540 |
| Policy instance | 9 |
| Insurance contract or identification number | VAR 206540 | | Number of Individuals Covered | 609 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $8,008 | | Other welfare benefits provided | ACCIDENTAL DEATH & 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 $8,008 | | Insurance broker name | MARSH & MCLENNAN |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 007499 |
| Policy instance | 10 |
| Insurance contract or identification number | 007499 | | Number of Individuals Covered | 1467 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $80,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $80,378 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045279 |
| Policy instance | 11 |
| Insurance contract or identification number | 30045279 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $522 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $522 | | Insurance broker name | LIGHTHOUSE INSURANCE GROUP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 007499 |
| Policy instance | 2 |
| Insurance contract or identification number | 007499 | | Number of Individuals Covered | 1582 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $192,433 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $192,433 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 48311 |
| Policy instance | 3 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 3003-2K |
| Policy instance | 4 |
| Insurance contract or identification number | 3003-2K | | Number of Individuals Covered | 4 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 191510 S001 |
| Policy instance | 5 |
| Insurance contract or identification number | 191510 S001 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $6,692 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,692 | | Insurance broker name | ROGUS, EVE |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153817 |
| Policy instance | 7 |
| Insurance contract or identification number | GL 153817 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $5,479 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,479 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045279 |
| Policy instance | 6 |
| Insurance contract or identification number | 30045279 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $563 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $563 | | Insurance broker name | LIGHTHOUSE INSURANCE GROUP |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 125066 |
| Policy instance | 10 |
| Insurance contract or identification number | LTD 125066 | | Number of Individuals Covered | 1723 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $3,277 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,277 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 153839 |
| Policy instance | 8 |
| Insurance contract or identification number | GL 153839 | | Number of Individuals Covered | 1883 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $6,630 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,630 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206540 |
| Policy instance | 9 |
| Insurance contract or identification number | VAR 206540 | | Number of Individuals Covered | 609 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $1,205 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,205 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 028185 |
| Policy instance | 1 |
| Insurance contract or identification number | 028185 | | Number of Individuals Covered | 1912 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $60,733 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,733 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 3003-2K |
| Policy instance | 6 |
| Insurance contract or identification number | 3003-2K | | Number of Individuals Covered | 6 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00348374 |
| Policy instance | 5 |
| Insurance contract or identification number | 00348374 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,321 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,275 | | Insurance broker name | LUCIDO MORRIS ASSOCIATES LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 48311 |
| Policy instance | 4 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 007499 |
| Policy instance | 3 |
| Insurance contract or identification number | 007499 | | Number of Individuals Covered | 1557 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $204,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $204,910 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 191510 S001 |
| Policy instance | 7 |
| Insurance contract or identification number | 191510 S001 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,917 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,917 | | Insurance broker name | ROGUS, EVE |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 028185 |
| Policy instance | 2 |
| Insurance contract or identification number | 028185 | | Number of Individuals Covered | 1838 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $3,191 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,191 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 028185 |
| Policy instance | 1 |
| Insurance contract or identification number | 028185 | | Number of Individuals Covered | 1799 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $6,674 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,674 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 48311 |
| Policy instance | 2 |
| Insurance contract or identification number | 48311 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-13 | | Total amount of commissions paid to insurance broker | USD $2,170 | | Welfare Benefit Premiums Paid to Carrier | USD $345,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,170 | | Insurance broker name | F.B.P. INSURANCE SERVICES, INC. |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 191510 |
| Policy instance | 1 |
| Insurance contract or identification number | 191510 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,098 | | Welfare Benefit Premiums Paid to Carrier | USD $281,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,098 | | Insurance broker name | ROGUS EVE |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 028185 |
| Policy instance | 4 |
| Insurance contract or identification number | 028185 | | Number of Individuals Covered | 1805 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $112,339 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $868,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,617 | | Insurance broker name | TRION |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 007499 |
| Policy instance | 3 |
| Insurance contract or identification number | 007499 | | Number of Individuals Covered | 1495 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $189,736 | | Welfare Benefit Premiums Paid to Carrier | USD $707,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,365 | | Insurance broker name | TRION GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 028185 |
| Policy instance | 1 |
| Insurance contract or identification number | 028185 | | Number of Individuals Covered | 1462 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $98,997 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $559,226 | | 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 | 48311-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 48311-0000 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,681 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $350,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00348374 |
| Policy instance | 4 |
| Insurance contract or identification number | 00348374 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $3,409 | | Total amount of fees paid to insurance company | USD $1,661 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,775 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 191510 |
| Policy instance | 5 |
| Insurance contract or identification number | 191510 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,098 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $281,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 007499 |
| Policy instance | 6 |
| Insurance contract or identification number | 007499 | | Number of Individuals Covered | 1384 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $193,000 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,107,275 | | 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 | 3003-2K |
| Policy instance | 7 |
| Insurance contract or identification number | 3003-2K | | Number of Individuals Covered | 4 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 14868-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 14868-001 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 584467 |
| Policy instance | 1 |
| Insurance contract or identification number | 584467 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $9,612 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 14868-001 |
| Policy instance | 10 |
| Insurance contract or identification number | 14868-001 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,863 | | 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 | 3003-2K |
| Policy instance | 9 |
| Insurance contract or identification number | 3003-2K | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 509230 |
| Policy instance | 8 |
| Insurance contract or identification number | 509230 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $22,471 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $146,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 007499 |
| Policy instance | 7 |
| Insurance contract or identification number | 007499 | | Number of Individuals Covered | 1063 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $135,047 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $709,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 191510 |
| Policy instance | 6 |
| Insurance contract or identification number | 191510 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,354 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $312,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00348374 |
| Policy instance | 5 |
| Insurance contract or identification number | 00348374 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $3,438 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,342 | | 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 | 48311-0000 |
| Policy instance | 4 |
| Insurance contract or identification number | 48311-0000 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $7,620 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $271,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 14868-001 |
| Policy instance | 3 |
| Insurance contract or identification number | 14868-001 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 028185 |
| Policy instance | 2 |
| Insurance contract or identification number | 028185 | | Number of Individuals Covered | 1401 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $79,973 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $430,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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