401k Plan data: MEDICAL INSURANCE plan

MEDICAL INSURANCE 401k Plan overview

Plan Name	MEDICAL INSURANCE
Plan identification number	502

MEDICAL INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

HEMMING MORSE LLP has sponsored the creation of one or more 401k plans.

Company Name: HEMMING MORSE LLP

Employer identification number (EIN): 300702322

NAIC Classification: 541211
NAIC Description: Offices of Certified Public Accountants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 TROY ATKINSON
502 2016-01-01 GREG MCKINNON 2019-02-27
502 2015-01-01 TROY ATKINSON
502 2014-01-01 TROY ATKINSON
502 2013-01-01 TROY ATKINSON
502 2012-01-01 TROY ATKINSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2016-01-01	TROY ATKINSON
502	2016-01-01	GREG MCKINNON	2019-02-27
502	2015-01-01	TROY ATKINSON
502	2014-01-01	TROY ATKINSON
502	2013-01-01	TROY ATKINSON
502	2012-01-01	TROY ATKINSON

Plan Statistics for MEDICAL INSURANCE

401k plan membership statisitcs for MEDICAL INSURANCE

Measure Date Value
2016: MEDICAL INSURANCE 2016 401k membership
Total participants, beginning-of-year 2016-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 33
Total of all active and inactive participants 2016-01-01 33
2015: MEDICAL INSURANCE 2015 401k membership
Total participants, beginning-of-year 2015-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 34
Total of all active and inactive participants 2015-01-01 34
2014: MEDICAL INSURANCE 2014 401k membership
Total participants, beginning-of-year 2014-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 80
Total of all active and inactive participants 2014-01-01 80
2013: MEDICAL INSURANCE 2013 401k membership
Total participants, beginning-of-year 2013-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 38
Total of all active and inactive participants 2013-01-01 38
2012: MEDICAL INSURANCE 2012 401k membership
Total participants, beginning-of-year 2012-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 84
Total of all active and inactive participants 2012-01-01 84

Measure	Date	Value
2016: MEDICAL INSURANCE 2016 401k membership
Total participants, beginning-of-year	2016-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	33
Total of all active and inactive participants	2016-01-01	33
2015: MEDICAL INSURANCE 2015 401k membership
Total participants, beginning-of-year	2015-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	34
Total of all active and inactive participants	2015-01-01	34
2014: MEDICAL INSURANCE 2014 401k membership
Total participants, beginning-of-year	2014-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	80
Total of all active and inactive participants	2014-01-01	80
2013: MEDICAL INSURANCE 2013 401k membership
Total participants, beginning-of-year	2013-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	38
Total of all active and inactive participants	2013-01-01	38
2012: MEDICAL INSURANCE 2012 401k membership
Total participants, beginning-of-year	2012-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	84
Total of all active and inactive participants	2012-01-01	84

Form 5500 Responses for MEDICAL INSURANCE

2016: MEDICAL INSURANCE 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MEDICAL INSURANCE 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MEDICAL INSURANCE 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MEDICAL INSURANCE 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MEDICAL INSURANCE 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

19566

Policy instance

Insurance contract or identification number	19566
Number of Individuals Covered	87
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,595
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $431,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,595
Insurance broker organization code?	3
Insurance broker name	HOVER INSURANCE SERVICES INC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

19566

Policy instance

Insurance contract or identification number	19566
Number of Individuals Covered	80
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,830
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 $419,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,830
Insurance broker organization code?	3
Insurance broker name	HOVER INSURANCE SERVICES INC

GROUP INSURANCE TRUST OF THE CALIFORNIA SOCIETY OF CPAS (National Association of Insurance Commissioners NAIC id number: W4404 )

Policy contract number

104085

Policy instance

Insurance contract or identification number	104085
Number of Individuals Covered	80
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,595
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,595
Insurance broker name	HOVER INSURANCE SERVICES INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12017160

Policy instance

Insurance contract or identification number	12017160
Number of Individuals Covered	0
Insurance policy start date	2012-05-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $960
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $960
Insurance broker organization code?	3
Insurance broker name	HOVER INSURANCE SERVICES INC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

19566

Policy instance

Insurance contract or identification number	19566
Number of Individuals Covered	38
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,179
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 $350,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,179
Insurance broker organization code?	3
Insurance broker name	HOVER INSURANCE SERVICES INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12017160

Policy instance

Insurance contract or identification number	12017160
Number of Individuals Covered	89
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $1,256
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,256
Insurance broker organization code?	3
Insurance broker name	HOVER INSURANCE SERVICES INC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

19566

Policy instance

Insurance contract or identification number	19566
Number of Individuals Covered	65
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,055
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 $299,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,055
Insurance broker organization code?	3
Insurance broker name	HOVER INSURANCE SERVICES INC

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Company Name:	HEMMING MORSE LLP
Employer identification number (EIN):	300702322
NAIC Classification:	541211
NAIC Description:	Offices of Certified Public Accountants