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SYSTEMS & SOFTWARE ENTERPRISES, LLC DBA ZODIAC INFLIGHT INNOVATIONS EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan NameSYSTEMS & SOFTWARE ENTERPRISES, LLC DBA ZODIAC INFLIGHT INNOVATIONS EMPLOYEE BENEFITS PLAN
Plan identification number 501

SYSTEMS & SOFTWARE ENTERPRISES, LLC DBA ZODIAC INFLIGHT INNOVATIONS EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    SYSTEMS & SOFTWARE ENTERPRISES, LLC has sponsored the creation of one or more 401k plans.

    Company Name:SYSTEMS & SOFTWARE ENTERPRISES, LLC
    Employer identification number (EIN):300708432
    NAIC Classification:541511
    NAIC Description:Custom Computer Programming Services

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan SYSTEMS & SOFTWARE ENTERPRISES, LLC DBA ZODIAC INFLIGHT INNOVATIONS EMPLOYEE BENEFITS PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-01-01AMBER JOHNSON2020-10-14
    5012018-09-01KIMMO SJOROOS
    5012017-09-01KIMMO SJOROOS
    5012016-09-01KIMMO SJOROOS
    5012016-06-01KIMMO SJOROOS
    5012015-06-01KIMMO SJOROOS
    5012014-06-01KIMMO SJOROOS
    5012013-06-01EDMUNDO BARRERA
    5012012-06-01EDMUNDO BARRERA

    Plan Statistics for SYSTEMS & SOFTWARE ENTERPRISES, LLC DBA ZODIAC INFLIGHT INNOVATIONS EMPLOYEE BENEFITS PLAN

    401k plan membership statisitcs for SYSTEMS & SOFTWARE ENTERPRISES, LLC DBA ZODIAC INFLIGHT INNOVATIONS EMPLOYEE BENEFITS PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-01-01364
    Total number of active participants reported on line 7a of the Form 55002019-01-010
    Number of retired or separated participants receiving benefits2019-01-010
    Number of other retired or separated participants entitled to future benefits2019-01-010
    Total of all active and inactive participants2019-01-010
    2018
    Total participants, beginning-of-year2018-09-01349
    Total number of active participants reported on line 7a of the Form 55002018-09-01364
    Number of retired or separated participants receiving benefits2018-09-016
    Number of other retired or separated participants entitled to future benefits2018-09-0110
    Total of all active and inactive participants2018-09-01380
    2017
    Total participants, beginning-of-year2017-09-01313
    Total number of active participants reported on line 7a of the Form 55002017-09-01349
    Number of retired or separated participants receiving benefits2017-09-017
    Number of other retired or separated participants entitled to future benefits2017-09-015
    Total of all active and inactive participants2017-09-01361
    2016
    Total participants, beginning-of-year2016-09-01277
    Total number of active participants reported on line 7a of the Form 55002016-09-01313
    Number of retired or separated participants receiving benefits2016-09-012
    Number of other retired or separated participants entitled to future benefits2016-09-013
    Total of all active and inactive participants2016-09-01318
    Total participants, beginning-of-year2016-06-01272
    Total number of active participants reported on line 7a of the Form 55002016-06-01277
    Number of retired or separated participants receiving benefits2016-06-012
    Number of other retired or separated participants entitled to future benefits2016-06-018
    Total of all active and inactive participants2016-06-01287
    2015
    Total participants, beginning-of-year2015-06-01213
    Total number of active participants reported on line 7a of the Form 55002015-06-01263
    Number of retired or separated participants receiving benefits2015-06-010
    Number of other retired or separated participants entitled to future benefits2015-06-010
    Total of all active and inactive participants2015-06-01263
    2014
    Total participants, beginning-of-year2014-06-01234
    Total number of active participants reported on line 7a of the Form 55002014-06-01255
    Number of retired or separated participants receiving benefits2014-06-015
    Number of other retired or separated participants entitled to future benefits2014-06-010
    Total of all active and inactive participants2014-06-01260
    2013
    Total participants, beginning-of-year2013-06-01261
    Total number of active participants reported on line 7a of the Form 55002013-06-01227
    Number of retired or separated participants receiving benefits2013-06-017
    Number of other retired or separated participants entitled to future benefits2013-06-010
    Total of all active and inactive participants2013-06-01234
    2012
    Total participants, beginning-of-year2012-06-01187
    Total number of active participants reported on line 7a of the Form 55002012-06-01259
    Number of retired or separated participants receiving benefits2012-06-012
    Number of other retired or separated participants entitled to future benefits2012-06-010
    Total of all active and inactive participants2012-06-01261

    Form 5500 Responses

    2019
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Submission has been amendedNo
    2019-01-01This submission is the final filingYes
    2019-01-01This return/report is a short plan year return/report (less than 12 months)No
    2019-01-01Plan is a collectively bargained planNo
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-09-01Type of plan entitySingle employer plan
    2018-09-01Submission has been amendedNo
    2018-09-01This submission is the final filingNo
    2018-09-01This return/report is a short plan year return/report (less than 12 months)Yes
    2018-09-01Plan is a collectively bargained planNo
    2018-09-01Plan funding arrangement – InsuranceYes
    2018-09-01Plan funding arrangement – General assets of the sponsorYes
    2018-09-01Plan benefit arrangement – InsuranceYes
    2018-09-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-09-01Type of plan entitySingle employer plan
    2017-09-01Submission has been amendedNo
    2017-09-01This submission is the final filingNo
    2017-09-01This return/report is a short plan year return/report (less than 12 months)No
    2017-09-01Plan is a collectively bargained planNo
    2017-09-01Plan funding arrangement – InsuranceYes
    2017-09-01Plan funding arrangement – General assets of the sponsorYes
    2017-09-01Plan benefit arrangement – InsuranceYes
    2017-09-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-09-01Type of plan entitySingle employer plan
    2016-09-01Submission has been amendedNo
    2016-09-01This submission is the final filingNo
    2016-09-01This return/report is a short plan year return/report (less than 12 months)No
    2016-09-01Plan is a collectively bargained planNo
    2016-09-01Plan funding arrangement – InsuranceYes
    2016-09-01Plan funding arrangement – General assets of the sponsorYes
    2016-09-01Plan benefit arrangement – InsuranceYes
    2016-09-01Plan benefit arrangement – General assets of the sponsorYes
    2016-06-01Type of plan entitySingle employer plan
    2016-06-01Submission has been amendedNo
    2016-06-01This submission is the final filingNo
    2016-06-01This return/report is a short plan year return/report (less than 12 months)Yes
    2016-06-01Plan is a collectively bargained planNo
    2016-06-01Plan funding arrangement – InsuranceYes
    2016-06-01Plan funding arrangement – General assets of the sponsorYes
    2016-06-01Plan benefit arrangement – InsuranceYes
    2016-06-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-06-01Type of plan entitySingle employer plan
    2015-06-01Submission has been amendedNo
    2015-06-01This submission is the final filingNo
    2015-06-01This return/report is a short plan year return/report (less than 12 months)No
    2015-06-01Plan is a collectively bargained planNo
    2015-06-01Plan funding arrangement – InsuranceYes
    2015-06-01Plan funding arrangement – General assets of the sponsorYes
    2015-06-01Plan benefit arrangement – InsuranceYes
    2015-06-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-06-01Type of plan entitySingle employer plan
    2014-06-01Submission has been amendedNo
    2014-06-01This submission is the final filingNo
    2014-06-01This return/report is a short plan year return/report (less than 12 months)No
    2014-06-01Plan is a collectively bargained planNo
    2014-06-01Plan funding arrangement – General assets of the sponsorYes
    2014-06-01Plan benefit arrangement – InsuranceYes
    2014-06-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-06-01Type of plan entitySingle employer plan
    2013-06-01Submission has been amendedNo
    2013-06-01This submission is the final filingNo
    2013-06-01This return/report is a short plan year return/report (less than 12 months)No
    2013-06-01Plan is a collectively bargained planNo
    2013-06-01Plan funding arrangement – General assets of the sponsorYes
    2013-06-01Plan benefit arrangement – InsuranceYes
    2013-06-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-06-01Type of plan entitySingle employer plan
    2012-06-01Submission has been amendedNo
    2012-06-01This submission is the final filingNo
    2012-06-01This return/report is a short plan year return/report (less than 12 months)No
    2012-06-01Plan is a collectively bargained planNo
    2012-06-01Plan funding arrangement – General assets of the sponsorYes
    2012-06-01Plan benefit arrangement – InsuranceYes
    2012-06-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
    Policy contract numberE4202347
    Policy instance 5
    Insurance contract or identification numberE4202347
    Number of Individuals Covered10
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $3,043
    Total amount of fees paid to insurance companyUSD $268
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,124
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,043
    Amount paid for insurance broker fees268
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 4
    Insurance contract or identification number661707
    Number of Individuals Covered387
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $17,990
    Total amount of fees paid to insurance companyUSD $4,261
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,831
    Amount paid for insurance broker fees2226
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 3
    Insurance contract or identification number228889
    Number of Individuals Covered366
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $65,103
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,651,203
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $65,103
    Insurance broker organization code?3
    ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered392
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $104,598
    Total amount of fees paid to insurance companyUSD $51,124
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,584,665
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $104,598
    Insurance broker organization code?3
    Amount paid for insurance broker fees51124
    Additional information about fees paid to insurance brokerFEES
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 1
    Insurance contract or identification number276584
    Number of Individuals Covered392
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $104,598
    Total amount of fees paid to insurance companyUSD $51,124
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,443,229
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $104,598
    Insurance broker organization code?3
    Amount paid for insurance broker fees51124
    Additional information about fees paid to insurance brokerFEES
    ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered352
    Insurance policy start date2018-09-01
    Insurance policy end date2018-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedSUPPLEMENTAL LIFE, DEPENDENT LIFE, SUPPLEMENTAL AD&D, DEPENDENT AD&D, AD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $489,725
    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: 00000 )
    Policy contract number228889
    Policy instance 3
    Insurance contract or identification number228889
    Number of Individuals Covered309
    Insurance policy start date2018-09-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $19,384
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $508,886
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,384
    Insurance broker organization code?3
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 1
    Insurance contract or identification number276584
    Number of Individuals Covered210
    Insurance policy start date2018-09-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $33,509
    Total amount of fees paid to insurance companyUSD $17,504
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $326,169
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $33,509
    Insurance broker organization code?3
    Amount paid for insurance broker fees17504
    Additional information about fees paid to insurance brokerFEES
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 4
    Insurance contract or identification number661707
    Number of Individuals Covered344
    Insurance policy start date2018-09-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $3,566
    Total amount of fees paid to insurance companyUSD $845
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,751
    Amount paid for insurance broker fees441
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered342
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $83,580
    Total amount of fees paid to insurance companyUSD $43,065
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedSUPPLEMENTAL LIFE, DEPENDENT LIFE, SUPPLEMENTAL AD&D, DEPENDENT AD&D, AD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,310,291
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $60,785
    Insurance broker organization code?3
    Amount paid for insurance broker fees43065
    Additional information about fees paid to insurance brokerFEES
    Insurance broker nameROMERO & LEVIN INSURANCE SERVICES
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 3
    Insurance contract or identification number228889
    Number of Individuals Covered264
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $46,023
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,260,167
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $23,984
    Insurance broker organization code?3
    Insurance broker nameROMERO & LEVIN WEALTH MANAGEMENT
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 4
    Insurance contract or identification number661707
    Number of Individuals Covered349
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $17,631
    Total amount of fees paid to insurance companyUSD $4,052
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,655
    Amount paid for insurance broker fees2128
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    Insurance broker nameMULROY INSURANCE AGENCY LLC
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 1
    Insurance contract or identification number276584
    Number of Individuals Covered77
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $938,720
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 4
    Insurance contract or identification number661707
    Number of Individuals Covered277
    Insurance policy start date2016-06-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $3,333
    Total amount of fees paid to insurance companyUSD $709
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,636
    Amount paid for insurance broker fees378
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    Insurance broker nameMULROY INSURANCE AGENCY LLC
    ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
    Policy contract number276584
    Policy instance 3
    Insurance contract or identification number276584
    Number of Individuals Covered281
    Insurance policy start date2016-06-01
    Insurance policy end date2016-08-31
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, SUPPLEMENTAL LIFE, SUPPLEMENTAL AD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $23,919
    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 number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered156
    Insurance policy start date2016-06-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $17,326
    Total amount of fees paid to insurance companyUSD $8,826
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $394,460
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,326
    Insurance broker organization code?3
    Amount paid for insurance broker fees8826
    Additional information about fees paid to insurance brokerFEES
    Insurance broker nameWARNER PACIFIC INSURANCE SERVICES
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 1
    Insurance contract or identification number228889
    Number of Individuals Covered181
    Insurance policy start date2016-06-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $7,833
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $200,003
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,833
    Insurance broker organization code?3
    Insurance broker nameROMERO & LEVIN WEALTH MANAGEMENT
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 4
    Insurance contract or identification number661707
    Number of Individuals Covered263
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $14,669
    Total amount of fees paid to insurance companyUSD $3,092
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,466
    Amount paid for insurance broker fees1955
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    Insurance broker nameMULROY INSURANCE AGENCY LLC
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 3
    Insurance contract or identification number228889
    Number of Individuals Covered165
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $27,328
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $740,497
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $27,328
    Insurance broker organization code?3
    Insurance broker nameROMERO & LEVIN WEALTH MANAGEMENT
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered72
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $769,024
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
    Policy contract number276584
    Policy instance 1
    Insurance contract or identification number276584
    Number of Individuals Covered148
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $69,455
    Total amount of fees paid to insurance companyUSD $35,676
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, SUPPLEMENTAL LIFE, SUPPLEMENTAL AD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $973,720
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $69,455
    Insurance broker organization code?3
    Amount paid for insurance broker fees35676
    Additional information about fees paid to insurance brokerFEES
    Insurance broker nameWARNER PACIFIC INSURANCE SERVICES
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 3
    Insurance contract or identification number661707
    Number of Individuals Covered227
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $9,583
    Total amount of fees paid to insurance companyUSD $1,913
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,583
    Amount paid for insurance broker fees1913
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNORTHWESTERN MUTUAL
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered255
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $55,270
    Total amount of fees paid to insurance companyUSD $29,676
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,371,722
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $55,270
    Insurance broker organization code?3
    Amount paid for insurance broker fees29676
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker nameWARNER PACIFIC INSURANCE SERVICES
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 1
    Insurance contract or identification number228889
    Number of Individuals Covered124
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $21,444
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $539,687
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $21,444
    Insurance broker organization code?3
    Insurance broker nameROMERO & LEVIN WEALTH MANAGEMENT
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered227
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $47,018
    Total amount of fees paid to insurance companyUSD $25,305
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,143,110
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $47,018
    Insurance broker organization code?3
    Amount paid for insurance broker fees25305
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker nameWARNER PACIFIC INSURANCE SERVICES
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number663496
    Policy instance 3
    Insurance contract or identification number663496
    Number of Individuals Covered259
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $3,165
    Total amount of fees paid to insurance companyUSD $671
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,165
    Amount paid for insurance broker fees671
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNORTHWESTERN MUTUAL
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number663496
    Policy instance 4
    Insurance contract or identification number663496
    Number of Individuals Covered227
    Insurance policy start date2013-09-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $2,228
    Total amount of fees paid to insurance companyUSD $472
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,228
    Amount paid for insurance broker fees472
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNORTHWESTERN MUTUAL
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number663496
    Policy instance 5
    Insurance contract or identification number663496
    Number of Individuals Covered259
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $1,326
    Total amount of fees paid to insurance companyUSD $281
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,326
    Amount paid for insurance broker fees281
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNORTHWESTERN MUTUAL
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 6
    Insurance contract or identification number228889
    Number of Individuals Covered106
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $16,046
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $394,432
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16,046
    Insurance broker organization code?3
    Insurance broker nameROMERO & LEVIN WEALTH MANAGEMENT
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number663496
    Policy instance 1
    Insurance contract or identification number663496
    Number of Individuals Covered227
    Insurance policy start date2013-09-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $954
    Total amount of fees paid to insurance companyUSD $202
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $954
    Amount paid for insurance broker fees202
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNORTHWESTERN MUTUAL
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number276584
    Policy instance 2
    Insurance contract or identification number276584
    Number of Individuals Covered259
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $52,060
    Total amount of fees paid to insurance companyUSD $24,010
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,187,225
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $52,060
    Insurance broker organization code?3
    Amount paid for insurance broker fees24010
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker nameWARNER PACIFIC INSURANCE SERVICES
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number228889
    Policy instance 3
    Insurance contract or identification number228889
    Number of Individuals Covered86
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $11,617
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $296,153
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,040
    Insurance broker organization code?3
    Insurance broker nameA.J. LONGO & ASSOCIATES
    NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
    Policy contract number661707
    Policy instance 1
    Insurance contract or identification number661707
    Number of Individuals Covered201
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $4,085
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $53,866
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,064
    Insurance broker organization code?3
    Insurance broker nameNONIE DE SURRA

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