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THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 401k Plan overview

Plan NameTHE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES
Plan identification number 510

THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision

401k Sponsoring company profile

THE CLOROX COMPANY has sponsored the creation of one or more 401k plans.

Company Name:THE CLOROX COMPANY
Employer identification number (EIN):310595760
NAIC Classification:325600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102021-07-01KIRSTEN MARRINER2023-04-05
5102020-07-01KIRSTEN MARRINER2022-04-03
5102019-07-01KIRSTEN MARRINER2021-04-02
5102018-07-01KIRSTEN MARRINER2020-04-01

Plan Statistics for THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES

401k plan membership statisitcs for THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES

Measure Date Value
2021: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2021 401k membership
Total participants, beginning-of-year2021-07-01816
Total number of active participants reported on line 7a of the Form 55002021-07-010
Number of retired or separated participants receiving benefits2021-07-01782
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01782
2020: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2020 401k membership
Total participants, beginning-of-year2020-07-01859
Total number of active participants reported on line 7a of the Form 55002020-07-010
Number of retired or separated participants receiving benefits2020-07-01803
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01803
2019: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2019 401k membership
Total participants, beginning-of-year2019-07-01128
Total number of active participants reported on line 7a of the Form 55002019-07-010
Number of retired or separated participants receiving benefits2019-07-01127
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01127
2018: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2018 401k membership
Total participants, beginning-of-year2018-07-01174
Total number of active participants reported on line 7a of the Form 55002018-07-010
Number of retired or separated participants receiving benefits2018-07-01155
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01155

Financial Data on THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES

Measure Date Value
2022 : THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$171,996
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$320,015
Total income from all sources (including contributions)2022-06-30$2,696,045
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$2,475,694
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$2,394,746
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$2,695,961
Value of total assets at end of year2022-06-30$753,801
Value of total assets at beginning of year2022-06-30$681,469
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$80,948
Total interest from all sources2022-06-30$84
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Administrative expenses professional fees incurred2022-06-30$80,948
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$1,627,788
Participant contributions at end of year2022-06-30$138,407
Participant contributions at beginning of year2022-06-30$185,828
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$220,351
Value of net assets at end of year (total assets less liabilities)2022-06-30$581,805
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$361,454
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-06-30$615,394
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-06-30$308,567
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-06-30$308,567
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$84
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$642,507
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30Yes
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$1,068,173
Employer contributions (assets) at end of year2022-06-30$0
Employer contributions (assets) at beginning of year2022-06-30$187,074
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$1,752,239
Liabilities. Value of benefit claims payable at end of year2022-06-30$171,996
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$320,015
Did the plan have assets held for investment2022-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30MOSS ADAMS LLP
Accountancy firm EIN2022-06-30910189318
2021 : THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$320,015
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$123,904
Total income from all sources (including contributions)2021-06-30$3,131,981
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$3,262,129
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$3,180,867
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$3,131,962
Value of total assets at end of year2021-06-30$681,469
Value of total assets at beginning of year2021-06-30$615,506
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$81,262
Total interest from all sources2021-06-30$19
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Administrative expenses professional fees incurred2021-06-30$81,262
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$1,377,842
Participant contributions at end of year2021-06-30$185,828
Participant contributions at beginning of year2021-06-30$122,218
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$-130,148
Value of net assets at end of year (total assets less liabilities)2021-06-30$361,454
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$491,602
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-06-30$308,567
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-06-30$493,288
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-06-30$493,288
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$19
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$706,584
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30Yes
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$1,754,120
Employer contributions (assets) at end of year2021-06-30$187,074
Employer contributions (assets) at beginning of year2021-06-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$2,474,283
Liabilities. Value of benefit claims payable at end of year2021-06-30$320,015
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$123,904
Did the plan have assets held for investment2021-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Unqualified
Accountancy firm name2021-06-30MOSS ADAMS LLP
Accountancy firm EIN2021-06-30910189318
2020 : THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$123,904
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$260,232
Total income from all sources (including contributions)2020-06-30$3,097,543
Total loss/gain on sale of assets2020-06-30$0
Total of all expenses incurred2020-06-30$2,859,631
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$2,774,533
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$3,094,636
Value of total assets at end of year2020-06-30$615,506
Value of total assets at beginning of year2020-06-30$513,922
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$85,098
Total interest from all sources2020-06-30$2,907
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Administrative expenses professional fees incurred2020-06-30$85,098
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$1,410,171
Participant contributions at end of year2020-06-30$122,218
Participant contributions at beginning of year2020-06-30$107,137
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$237,912
Value of net assets at end of year (total assets less liabilities)2020-06-30$491,602
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$253,690
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-06-30$493,288
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-06-30$406,785
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-06-30$406,785
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-06-30$2,907
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$525,223
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30Yes
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$1,684,465
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$2,249,310
Liabilities. Value of benefit claims payable at end of year2020-06-30$123,904
Liabilities. Value of benefit claims payable at beginning of year2020-06-30$260,232
Did the plan have assets held for investment2020-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30No
Opinion of an independent qualified public accountant for this plan2020-06-30Unqualified
Accountancy firm name2020-06-30MOSS ADAMS LLP
Accountancy firm EIN2020-06-30910189318
2019 : THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-06-30$0
Total transfer of assets to this plan2019-06-30$531,464
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$260,232
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$3,975,191
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$4,252,965
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$4,158,268
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$3,969,750
Value of total assets at end of year2019-06-30$513,922
Value of total assets at beginning of year2019-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$94,697
Total interest from all sources2019-06-30$5,441
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Administrative expenses professional fees incurred2019-06-30$94,697
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$1,462,845
Participant contributions at end of year2019-06-30$107,137
Participant contributions at beginning of year2019-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$-277,774
Value of net assets at end of year (total assets less liabilities)2019-06-30$253,690
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-06-30$406,785
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-06-30$5,441
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$410,202
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30Yes
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$2,506,905
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$3,748,066
Liabilities. Value of benefit claims payable at end of year2019-06-30$260,232
Liabilities. Value of benefit claims payable at beginning of year2019-06-30$0
Did the plan have assets held for investment2019-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30No
Opinion of an independent qualified public accountant for this plan2019-06-30Unqualified
Accountancy firm name2019-06-30MOSS ADAMS LLP
Accountancy firm EIN2019-06-30910189318

Form 5500 Responses for THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES

2021: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: THE CLOROX COMPANY GROUP INSURANCE PLAN FOR RETIREES 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01First time form 5500 has been submittedYes
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8455
Policy instance 1
Insurance contract or identification number8455
Number of Individuals Covered17
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 $250,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number645751
Policy instance 2
Insurance contract or identification number645751
Number of Individuals Covered641
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 $391,511
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 number8455
Policy instance 1
Insurance contract or identification number8455
Number of Individuals Covered21
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 $258,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number645751
Policy instance 2
Insurance contract or identification number645751
Number of Individuals Covered675
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 $447,684
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 number8455
Policy instance 1
Insurance contract or identification number8455
Number of Individuals Covered20
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
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 $243,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number645751
Policy instance 2
Insurance contract or identification number645751
Number of Individuals Covered716
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
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 $196,962
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 number8455
Policy instance 1
Insurance contract or identification number8455
Number of Individuals Covered20
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
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 $249,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number645751
Policy instance 2
Insurance contract or identification number645751
Number of Individuals Covered739
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
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 $158,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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