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EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 401k Plan overview

Plan NameEMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES
Plan identification number 547

EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Severance pay
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

PPG INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:PPG INDUSTRIES, INC.
Employer identification number (EIN):250730780
NAIC Classification:325500

Additional information about PPG INDUSTRIES, INC.

Jurisdiction of Incorporation: Alaska Department Commerce, Community & Economic Development
Incorporation Date: 1980-07-07
Company Identification Number: 22215D
Legal Registered Office Address: 2711 CENTERVILLE ROAD
SUITE 400
WILMINGTON
United States of America (USA)
19808

More information about PPG INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5472021-12-31
5472020-12-31
5472019-12-31
5472018-12-31
5472017-12-31
5472016-12-31
5472015-12-31KAREN P. RATHBURN
5472014-12-31KAREN P. RATHBURN
5472013-12-31KAREN P. RATHBURN JOHANN F. KOLLING2015-10-14
5472012-12-31KAREN P. RATHBURN JOHANN F. KOLLING2014-10-10
5472011-12-31KAREN P RATHBURN JOHANN F KOLLING2013-10-10
5472010-12-31KAREN P. RATHBURN JOHANN F. KOLLING2012-10-08
5472009-12-31KAREN P. RATHBURN JOHANN F. KOLLING2011-09-12
5472008-12-31

Plan Statistics for EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES

401k plan membership statisitcs for EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES

Measure Date Value
2021: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2021 401k membership
Total participants, beginning-of-year2021-12-3113,235
Total number of active participants reported on line 7a of the Form 55002021-12-3113,659
Total of all active and inactive participants2021-12-3113,659
Total participants2021-12-3113,659
2020: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2020 401k membership
Total participants, beginning-of-year2020-12-3112,336
Total number of active participants reported on line 7a of the Form 55002020-12-3113,235
Total of all active and inactive participants2020-12-3113,235
Total participants2020-12-3113,235
2019: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2019 401k membership
Total participants, beginning-of-year2019-12-3116,712
Total number of active participants reported on line 7a of the Form 55002019-12-3112,075
Number of retired or separated participants receiving benefits2019-12-31261
Total of all active and inactive participants2019-12-3112,336
Total participants2019-12-3112,336
2018: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2018 401k membership
Total participants, beginning-of-year2018-12-3114,823
Total number of active participants reported on line 7a of the Form 55002018-12-3113,989
Number of retired or separated participants receiving benefits2018-12-312,723
Total of all active and inactive participants2018-12-3116,712
Total participants2018-12-3116,712
2017: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2017 401k membership
Total participants, beginning-of-year2017-12-3111,646
Total number of active participants reported on line 7a of the Form 55002017-12-3114,471
Number of retired or separated participants receiving benefits2017-12-31352
Total of all active and inactive participants2017-12-3114,823
Total participants2017-12-3114,823
2016: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2016 401k membership
Total participants, beginning-of-year2016-12-3111,537
Total number of active participants reported on line 7a of the Form 55002016-12-3111,231
Number of retired or separated participants receiving benefits2016-12-31415
Total of all active and inactive participants2016-12-3111,646
Total participants2016-12-3111,646
2015: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2015 401k membership
Total participants, beginning-of-year2015-12-3111,127
Total number of active participants reported on line 7a of the Form 55002015-12-3111,066
Number of retired or separated participants receiving benefits2015-12-31471
Total of all active and inactive participants2015-12-3111,537
Total participants2015-12-310
2014: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2014 401k membership
Total participants, beginning-of-year2014-12-3111,791
Total number of active participants reported on line 7a of the Form 55002014-12-3110,577
Number of retired or separated participants receiving benefits2014-12-31550
Total of all active and inactive participants2014-12-3111,127
Total participants2014-12-310
2013: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2013 401k membership
Total participants, beginning-of-year2013-12-3111,358
Total number of active participants reported on line 7a of the Form 55002013-12-3111,014
Number of retired or separated participants receiving benefits2013-12-31777
Total of all active and inactive participants2013-12-3111,791
Total participants2013-12-310
2012: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2012 401k membership
Total participants, beginning-of-year2012-12-3111,758
Total number of active participants reported on line 7a of the Form 55002012-12-3110,566
Number of retired or separated participants receiving benefits2012-12-31792
Total of all active and inactive participants2012-12-3111,358
Total participants2012-12-310
2011: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2011 401k membership
Total participants, beginning-of-year2011-12-3111,396
Total number of active participants reported on line 7a of the Form 55002011-12-3110,784
Number of retired or separated participants receiving benefits2011-12-31974
Total of all active and inactive participants2011-12-3111,758
Total participants2011-12-3111,758
2010: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2010 401k membership
Total participants, beginning-of-year2010-12-3111,411
Total number of active participants reported on line 7a of the Form 55002010-12-3110,429
Number of retired or separated participants receiving benefits2010-12-31967
Total of all active and inactive participants2010-12-3111,396
Total participants2010-12-3111,396
2009: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2009 401k membership
Total participants, beginning-of-year2009-12-3112,523
Total number of active participants reported on line 7a of the Form 55002009-12-3110,279
Number of retired or separated participants receiving benefits2009-12-311,132
Total of all active and inactive participants2009-12-3111,411
Total participants2009-12-3111,411

Form 5500 Responses for EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES

2021: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2021 form 5500 responses
2021-12-31Type of plan entitySingle employer plan
2021-12-31Plan funding arrangement – InsuranceYes
2021-12-31Plan funding arrangement – General assets of the sponsorYes
2021-12-31Plan benefit arrangement – InsuranceYes
2021-12-31Plan benefit arrangement – General assets of the sponsorYes
2020: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2020 form 5500 responses
2020-12-31Type of plan entitySingle employer plan
2020-12-31Plan funding arrangement – InsuranceYes
2020-12-31Plan funding arrangement – General assets of the sponsorYes
2020-12-31Plan benefit arrangement – InsuranceYes
2020-12-31Plan benefit arrangement – General assets of the sponsorYes
2019: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2019 form 5500 responses
2019-12-31Type of plan entitySingle employer plan
2019-12-31Plan funding arrangement – InsuranceYes
2019-12-31Plan funding arrangement – General assets of the sponsorYes
2019-12-31Plan benefit arrangement – InsuranceYes
2019-12-31Plan benefit arrangement – General assets of the sponsorYes
2018: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2018 form 5500 responses
2018-12-31Type of plan entitySingle employer plan
2018-12-31Plan funding arrangement – InsuranceYes
2018-12-31Plan funding arrangement – General assets of the sponsorYes
2018-12-31Plan benefit arrangement – InsuranceYes
2018-12-31Plan benefit arrangement – General assets of the sponsorYes
2017: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2017 form 5500 responses
2017-12-31Type of plan entitySingle employer plan
2017-12-31Plan funding arrangement – InsuranceYes
2017-12-31Plan funding arrangement – General assets of the sponsorYes
2017-12-31Plan benefit arrangement – InsuranceYes
2017-12-31Plan benefit arrangement – General assets of the sponsorYes
2016: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2016 form 5500 responses
2016-12-31Type of plan entitySingle employer plan
2016-12-31Plan funding arrangement – InsuranceYes
2016-12-31Plan funding arrangement – General assets of the sponsorYes
2016-12-31Plan benefit arrangement – InsuranceYes
2016-12-31Plan benefit arrangement – General assets of the sponsorYes
2015: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2015 form 5500 responses
2015-12-31Type of plan entitySingle employer plan
2015-12-31Plan funding arrangement – InsuranceYes
2015-12-31Plan funding arrangement – General assets of the sponsorYes
2015-12-31Plan benefit arrangement – InsuranceYes
2015-12-31Plan benefit arrangement – General assets of the sponsorYes
2014: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2014 form 5500 responses
2014-12-31Type of plan entitySingle employer plan
2014-12-31Plan funding arrangement – InsuranceYes
2014-12-31Plan funding arrangement – General assets of the sponsorYes
2014-12-31Plan benefit arrangement – InsuranceYes
2014-12-31Plan benefit arrangement – General assets of the sponsorYes
2013: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2013 form 5500 responses
2013-12-31Type of plan entitySingle employer plan
2013-12-31Plan funding arrangement – InsuranceYes
2013-12-31Plan funding arrangement – General assets of the sponsorYes
2013-12-31Plan benefit arrangement – InsuranceYes
2013-12-31Plan benefit arrangement – General assets of the sponsorYes
2012: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2012 form 5500 responses
2012-12-31Type of plan entitySingle employer plan
2012-12-31Plan funding arrangement – InsuranceYes
2012-12-31Plan funding arrangement – General assets of the sponsorYes
2012-12-31Plan benefit arrangement – InsuranceYes
2012-12-31Plan benefit arrangement – General assets of the sponsorYes
2011: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2011 form 5500 responses
2011-12-31Type of plan entitySingle employer plan
2011-12-31Plan funding arrangement – InsuranceYes
2011-12-31Plan funding arrangement – General assets of the sponsorYes
2011-12-31Plan benefit arrangement – InsuranceYes
2011-12-31Plan benefit arrangement – General assets of the sponsorYes
2010: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2010 form 5500 responses
2010-12-31Type of plan entitySingle employer plan
2010-12-31Plan funding arrangement – InsuranceYes
2010-12-31Plan funding arrangement – General assets of the sponsorYes
2010-12-31Plan benefit arrangement – InsuranceYes
2010-12-31Plan benefit arrangement – General assets of the sponsorYes
2009: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2009 form 5500 responses
2009-12-31Type of plan entitySingle employer plan
2009-12-31This submission is the final filingNo
2009-12-31Plan funding arrangement – InsuranceYes
2009-12-31Plan funding arrangement – General assets of the sponsorYes
2009-12-31Plan benefit arrangement – InsuranceYes
2009-12-31Plan benefit arrangement – General assets of the sponsorYes
2008: EMPLOYEE WELFARE PLAN-SALARIED EMPLOYEES 2008 form 5500 responses
2008-12-31Type of plan entitySingle employer plan
2008-12-31Submission has been amendedNo
2008-12-31This submission is the final filingNo
2008-12-31This return/report is a short plan year return/report (less than 12 months)No
2008-12-31Plan is a collectively bargained planNo

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number358102
Policy instance 6
Insurance contract or identification number358102
Number of Individuals Covered3505
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedSUPP LTD
Welfare Benefit Premiums Paid to CarrierUSD $702,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 )
Policy contract number113254
Policy instance 18
Insurance contract or identification number113254
Number of Individuals Covered32
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered5768
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,570,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberDE6170
Policy instance 2
Insurance contract or identification numberDE6170
Number of Individuals Covered5
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $332,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19682 )
Policy contract numberGTA-101507
Policy instance 3
Insurance contract or identification numberGTA-101507
Number of Individuals Covered13658
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedTRAVEL AND ACCIDENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19682 )
Policy contract numberGTA101506
Policy instance 4
Insurance contract or identification numberGTA101506
Number of Individuals Covered10
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CNR
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681077
Policy instance 5
Insurance contract or identification number681077
Number of Individuals Covered12659
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,406,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 7
Insurance contract or identification numberVARIOUS
Number of Individuals Covered6256
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Were dividends or retroactive rate refunds paid as a credit?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 number102745-000
Policy instance 8
Insurance contract or identification number102745-000
Number of Individuals Covered700
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $8,798,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6036796
Policy instance 9
Insurance contract or identification number6036796
Number of Individuals Covered12283
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $342,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number1-10460-001
Policy instance 10
Insurance contract or identification number1-10460-001
Number of Individuals Covered107
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $686,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 17
Insurance contract or identification numberN/A
Number of Individuals Covered13659
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $426,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0210808
Policy instance 16
Insurance contract or identification number0210808
Number of Individuals Covered8260
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedVOLUNTARY AD&D LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $581,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0214387
Policy instance 15
Insurance contract or identification number0214387
Number of Individuals Covered13658
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedSEAT BELT AD&D
Welfare Benefit Premiums Paid to CarrierUSD $111,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0229100
Policy instance 14
Insurance contract or identification number0229100
Number of Individuals Covered2988
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedBASIC CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $190,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number060303370
Policy instance 13
Insurance contract or identification number060303370
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,364
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 number28998
Policy instance 12
Insurance contract or identification number28998
Number of Individuals Covered12
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $175,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number679331
Policy instance 11
Insurance contract or identification number679331
Number of Individuals Covered13659
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $437,646
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 number102745-000
Policy instance 10
Insurance contract or identification number102745-000
Number of Individuals Covered670
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $7,563,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 9
Insurance contract or identification numberVARIOUS
Number of Individuals Covered5027
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number358102
Policy instance 8
Insurance contract or identification number358102
Number of Individuals Covered3643
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedSUPP LTD
Welfare Benefit Premiums Paid to CarrierUSD $930,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number357706
Policy instance 7
Insurance contract or identification number357706
Number of Individuals Covered12058
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,435,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00 VP 170001
Policy instance 6
Insurance contract or identification number00 VP 170001
Number of Individuals Covered61
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CHEMICAL
Welfare Benefit Premiums Paid to CarrierUSD $180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 200939
Policy instance 5
Insurance contract or identification numberETB 200939
Number of Individuals Covered1138
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CNR
Welfare Benefit Premiums Paid to CarrierUSD $1,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201141
Policy instance 4
Insurance contract or identification numberETB 201141
Number of Individuals Covered12
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedAD&D OUTSIDE BOARD OF DIRECTORS
Welfare Benefit Premiums Paid to CarrierUSD $1,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201322
Policy instance 3
Insurance contract or identification numberETB 201322
Number of Individuals Covered13235
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedTRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $15,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered4690
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,921,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberDE6170
Policy instance 2
Insurance contract or identification numberDE6170
Number of Individuals Covered6
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $308,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6036796
Policy instance 11
Insurance contract or identification number6036796
Number of Individuals Covered10010
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number1-10460-001
Policy instance 12
Insurance contract or identification number1-10460-001
Number of Individuals Covered107
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $709,402
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 number28998
Policy instance 14
Insurance contract or identification number28998
Number of Individuals Covered13
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $145,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number297064
Policy instance 22
Insurance contract or identification number297064
Number of Individuals Covered34
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $7,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number709497
Policy instance 21
Insurance contract or identification number709497
Number of Individuals Covered110
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $6,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number697331
Policy instance 19
Insurance contract or identification number697331
Number of Individuals Covered13235
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedLEAVE MANAGEMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0210808
Policy instance 18
Insurance contract or identification number0210808
Number of Individuals Covered8623
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedVOLUNTARY AD&D LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $609,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0214387
Policy instance 17
Insurance contract or identification number0214387
Number of Individuals Covered13235
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedSEAT BELT AD&D
Welfare Benefit Premiums Paid to CarrierUSD $96,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0229100
Policy instance 16
Insurance contract or identification number0229100
Number of Individuals Covered2595
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedBASIC CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $157,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number060303370
Policy instance 15
Insurance contract or identification number060303370
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number709497
Policy instance 20
Insurance contract or identification number709497
Number of Individuals Covered113
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedNY PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $38,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number342132
Policy instance 13
Insurance contract or identification number342132
Number of Individuals Covered13279
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $493,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 14
Insurance contract or identification numberVARIOUS
Number of Individuals Covered6538
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number2181830000
Policy instance 13
Insurance contract or identification number2181830000
Number of Individuals Covered438
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $213,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number358102
Policy instance 12
Insurance contract or identification number358102
Number of Individuals Covered3656
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedSUPP LTD
Welfare Benefit Premiums Paid to CarrierUSD $983,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number357706
Policy instance 11
Insurance contract or identification number357706
Number of Individuals Covered10769
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,245,120
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 number102745-000
Policy instance 15
Insurance contract or identification number102745-000
Number of Individuals Covered656
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $8,999,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number138058
Policy instance 16
Insurance contract or identification number138058
Number of Individuals Covered36
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,832,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6036796
Policy instance 17
Insurance contract or identification number6036796
Number of Individuals Covered10706
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $354,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number1-10460-001
Policy instance 18
Insurance contract or identification number1-10460-001
Number of Individuals Covered109
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $741,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number342132
Policy instance 19
Insurance contract or identification number342132
Number of Individuals Covered11801
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $453,247
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 number28998
Policy instance 20
Insurance contract or identification number28998
Number of Individuals Covered13
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $183,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number060303370
Policy instance 21
Insurance contract or identification number060303370
Number of Individuals Covered21
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00 VP 170001
Policy instance 10
Insurance contract or identification number00 VP 170001
Number of Individuals Covered62
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CHEMICAL
Welfare Benefit Premiums Paid to CarrierUSD $190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 200939
Policy instance 9
Insurance contract or identification numberETB 200939
Number of Individuals Covered1106
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CNR
Welfare Benefit Premiums Paid to CarrierUSD $1,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered2877
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,767,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberDE6170
Policy instance 2
Insurance contract or identification numberDE6170
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $468,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberTDI980008
Policy instance 3
Insurance contract or identification numberTDI980008
Number of Individuals Covered24
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $20,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD074526
Policy instance 4
Insurance contract or identification numberNYD074526
Number of Individuals Covered128
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $8,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00-ADD-S06751
Policy instance 5
Insurance contract or identification number00-ADD-S06751
Number of Individuals Covered12075
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedSEAT BELT AD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201322
Policy instance 6
Insurance contract or identification numberETB 201322
Number of Individuals Covered12075
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedTRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $16,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberADD S06129
Policy instance 7
Insurance contract or identification numberADD S06129
Number of Individuals Covered9957
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedVOLUNTARY AD&D LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $770,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201141
Policy instance 8
Insurance contract or identification numberETB 201141
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedAD&D OUTSIDE BOARD OF DIRECTORS
Welfare Benefit Premiums Paid to CarrierUSD $1,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number357706
Policy instance 11
Insurance contract or identification number357706
Number of Individuals Covered11257
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,230,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 200939
Policy instance 9
Insurance contract or identification numberETB 200939
Number of Individuals Covered1252
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CNR
Welfare Benefit Premiums Paid to CarrierUSD $1,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201141
Policy instance 8
Insurance contract or identification numberETB 201141
Number of Individuals Covered12
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedAD&D OUTSIDE BOARD OF DIRECTORS
Welfare Benefit Premiums Paid to CarrierUSD $1,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberADD S06129
Policy instance 7
Insurance contract or identification numberADD S06129
Number of Individuals Covered10049
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedVOLUNTARY AD&D LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $752,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00-ADD-S06751
Policy instance 5
Insurance contract or identification number00-ADD-S06751
Number of Individuals Covered14624
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedSEAT BELT AD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD074526
Policy instance 4
Insurance contract or identification numberNYD074526
Number of Individuals Covered66
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $81,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberTDI980008
Policy instance 3
Insurance contract or identification numberTDI980008
Number of Individuals Covered28
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $20,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberDE6170
Policy instance 2
Insurance contract or identification numberDE6170
Number of Individuals Covered30
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $390,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered4756
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,323,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201322
Policy instance 6
Insurance contract or identification numberETB 201322
Number of Individuals Covered14624
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedTRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $16,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00 VP 170001
Policy instance 10
Insurance contract or identification number00 VP 170001
Number of Individuals Covered72
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CHEMICAL
Welfare Benefit Premiums Paid to CarrierUSD $198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number358102
Policy instance 12
Insurance contract or identification number358102
Number of Individuals Covered4053
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedSUPP LTD
Welfare Benefit Premiums Paid to CarrierUSD $1,029,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number060303370
Policy instance 22
Insurance contract or identification number060303370
Number of Individuals Covered30
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,522
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 number28998
Policy instance 21
Insurance contract or identification number28998
Number of Individuals Covered15
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Welfare Benefit Premiums Paid to CarrierUSD $189,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number342132
Policy instance 20
Insurance contract or identification number342132
Number of Individuals Covered9862
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $372,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01559200
Policy instance 18
Insurance contract or identification number01559200
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number1-10460-001
Policy instance 19
Insurance contract or identification number1-10460-001
Number of Individuals Covered127
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $748,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6036796
Policy instance 17
Insurance contract or identification number6036796
Number of Individuals Covered11083
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $323,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number138058
Policy instance 16
Insurance contract or identification number138058
Number of Individuals Covered53
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $3,731,090
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 number102745-000
Policy instance 15
Insurance contract or identification number102745-000
Number of Individuals Covered766
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Welfare Benefit Premiums Paid to CarrierUSD $7,797,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 14
Insurance contract or identification numberVARIOUS
Number of Individuals Covered5662
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number2181830000
Policy instance 13
Insurance contract or identification number2181830000
Number of Individuals Covered699
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Welfare Benefit Premiums Paid to CarrierUSD $318,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberDE6170
Policy instance 2
Insurance contract or identification numberDE6170
Number of Individuals Covered12
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $442,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00 VP 170001
Policy instance 10
Insurance contract or identification number00 VP 170001
Number of Individuals Covered83
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CHEMICAL
Welfare Benefit Premiums Paid to CarrierUSD $171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 200939
Policy instance 9
Insurance contract or identification numberETB 200939
Number of Individuals Covered1381
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D FIRE SQUAD-CNR
Welfare Benefit Premiums Paid to CarrierUSD $1,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201141
Policy instance 8
Insurance contract or identification numberETB 201141
Number of Individuals Covered10
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedAD&D OUTSIDE BOARD OF DIRECTORS
Welfare Benefit Premiums Paid to CarrierUSD $1,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberADD S06129
Policy instance 7
Insurance contract or identification numberADD S06129
Number of Individuals Covered10448
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedVOLUNTARY AD&D LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $749,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract numberETB 201322
Policy instance 6
Insurance contract or identification numberETB 201322
Number of Individuals Covered14471
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedTRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $16,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number00-ADD-S06751
Policy instance 5
Insurance contract or identification number00-ADD-S06751
Number of Individuals Covered14471
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedSEAT BELT AD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD074526
Policy instance 4
Insurance contract or identification numberNYD074526
Number of Individuals Covered89
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $18,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberTDI980008
Policy instance 3
Insurance contract or identification numberTDI980008
Number of Individuals Covered30
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $22,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number357706
Policy instance 11
Insurance contract or identification number357706
Number of Individuals Covered11430
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,434,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number358102
Policy instance 12
Insurance contract or identification number358102
Number of Individuals Covered4154
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedSUPP LTD
Welfare Benefit Premiums Paid to CarrierUSD $996,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered8517
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,675,016
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 number28998
Policy instance 21
Insurance contract or identification number28998
Number of Individuals Covered13
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Welfare Benefit Premiums Paid to CarrierUSD $180,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number342132
Policy instance 20
Insurance contract or identification number342132
Number of Individuals Covered10928
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $437,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number1-10460-001
Policy instance 19
Insurance contract or identification number1-10460-001
Number of Individuals Covered124
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $931,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01559200
Policy instance 18
Insurance contract or identification number01559200
Number of Individuals Covered7
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6036796
Policy instance 17
Insurance contract or identification number6036796
Number of Individuals Covered11292
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $370,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number138058
Policy instance 16
Insurance contract or identification number138058
Number of Individuals Covered178
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $122,504
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 number102745-000
Policy instance 15
Insurance contract or identification number102745-000
Number of Individuals Covered723
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Welfare Benefit Premiums Paid to CarrierUSD $6,139,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 14
Insurance contract or identification numberVARIOUS
Number of Individuals Covered4863
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number2181830000
Policy instance 13
Insurance contract or identification number2181830000
Number of Individuals Covered669
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Welfare Benefit Premiums Paid to CarrierUSD $361,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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