A.M. CASTLE & CO. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE
401k plan membership statisitcs for A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE
Measure | Date | Value |
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2022: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 436 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 440 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 65 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 505 |
2021: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 447 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 427 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 9 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 436 |
2020: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 586 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 438 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 9 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 447 |
2019: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 656 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 580 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 586 |
2018: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 649 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 652 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 657 |
2017: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 977 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 640 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 9 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 649 |
2016: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 1,470 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 643 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 334 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 977 |
2015: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 1,614 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,150 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 320 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 1,470 |
2014: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 1,957 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,100 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 1,100 |
2013: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 1,182 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,940 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 17 |
Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
Total of all active and inactive participants | 2013-01-01 | 1,957 |
2012: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 1,218 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,165 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 17 |
Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
Total of all active and inactive participants | 2012-01-01 | 1,182 |
2011: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 1,083 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,201 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 17 |
Total of all active and inactive participants | 2011-01-01 | 1,218 |
Total participants | 2011-01-01 | 1,218 |
2010: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 977 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 1,069 |
Number of retired or separated participants receiving benefits | 2010-01-01 | 14 |
Total of all active and inactive participants | 2010-01-01 | 1,083 |
Total participants | 2010-01-01 | 1,083 |
2009: A.M. CASTLE & CO. NON-BARGAINING GROUP INSURANCE 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 1,451 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 923 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 54 |
Total of all active and inactive participants | 2009-01-01 | 977 |
Total participants | 2009-01-01 | 977 |
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 31 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $48 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $339,202 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 48 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 807623G,888855G |
Policy instance | 8 |
Insurance contract or identification number | 807623G,888855G | Number of Individuals Covered | 734 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $16,391 | Total amount of fees paid to insurance company | USD $23,276 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, VOLUNTARY: ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY | 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 Carrier | USD $505,032 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 23276 | Additional information about fees paid to insurance broker | FEES PAID, BONUS | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $16,391 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 738 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $25,274 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | PREPAID DENTAL | 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 Carrier | USD $645,475 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 25274 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97053441001 |
Policy instance | 2 |
Insurance contract or identification number | 97053441001 | Number of Individuals Covered | 804 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $46,429 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 12127821 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $6,080 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $60,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,080 | Insurance broker organization code? | 3 | Number of Individuals Covered | 77 | Total amount of fees paid to insurance company | USD $126 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Amount paid for insurance broker fees | 126 | Additional information about fees paid to insurance broker | BONUS |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 5 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 68 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | LEGAL | 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 Carrier | USD $10,157 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 908285 |
Policy instance | 6 |
Insurance contract or identification number | 908285 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $2,535 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | ADDN10846298 |
Policy instance | 7 |
Insurance contract or identification number | ADDN10846298 | Number of Individuals Covered | 953 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $412 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | 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 Carrier | USD $9,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $412 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 908285 |
Policy instance | 6 |
Insurance contract or identification number | 908285 | Number of Individuals Covered | 1 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 756 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of fees paid to insurance company | USD $26,093 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $564,870 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 26093 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 3441001,5701001 |
Policy instance | 2 |
Insurance contract or identification number | 3441001,5701001 | Number of Individuals Covered | 832 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 30 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $136,746 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 78 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $362,868 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 5 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 50 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $16,188 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | ADDN10846298 |
Policy instance | 7 |
Insurance contract or identification number | ADDN10846298 | Number of Individuals Covered | 685 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 807623G,888855G |
Policy instance | 8 |
Insurance contract or identification number | 807623G,888855G | Number of Individuals Covered | 879 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $16,012 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, VOLUNTARY: ACCIDENT, CI, HI | Welfare Benefit Premiums Paid to Carrier | USD $508,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,012 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 3441001,5701001 |
Policy instance | 2 |
Insurance contract or identification number | 3441001,5701001 | Number of Individuals Covered | 849 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,136 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 35 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $174,781 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 69 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $401,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-AD&D |
Policy instance | 5 |
Insurance contract or identification number | 0885565-AD&D | Number of Individuals Covered | 564 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-04-30 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,076 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 784 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of fees paid to insurance company | USD $30,556 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $562,839 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 30556 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DISABIL |
Policy instance | 7 |
Insurance contract or identification number | 0885565-DISABIL | Number of Individuals Covered | 404 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-04-30 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,303 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-TDI |
Policy instance | 8 |
Insurance contract or identification number | 0885565-TDI | Number of Individuals Covered | 1520 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-04-30 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,013 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 9 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 80 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $18,947 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 908285 |
Policy instance | 10 |
Insurance contract or identification number | 908285 | Number of Individuals Covered | 584 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Other welfare benefits provided | BTM | Welfare Benefit Premiums Paid to Carrier | USD $4,127 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | ADD N10846298 |
Policy instance | 11 |
Insurance contract or identification number | ADD N10846298 | Number of Individuals Covered | 584 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Other welfare benefits provided | BTA | Welfare Benefit Premiums Paid to Carrier | USD $9,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 807623G,888855G |
Policy instance | 12 |
Insurance contract or identification number | 807623G,888855G | Number of Individuals Covered | 790 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $15,740 | Total amount of fees paid to insurance company | USD $6,620 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, VOLUNTARY: ACCIDENT, CI, HI | Welfare Benefit Premiums Paid to Carrier | USD $296,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,740 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 6620 | Additional information about fees paid to insurance broker | BONUS |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DEATH |
Policy instance | 6 |
Insurance contract or identification number | 0885565-DEATH | Number of Individuals Covered | 1431 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-04-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,398 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DEATH |
Policy instance | 6 |
Insurance contract or identification number | 0885565-DEATH | Number of Individuals Covered | 1338 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $227,107 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 90 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $462,613 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 32 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $167,659 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 3441001,5701001 |
Policy instance | 2 |
Insurance contract or identification number | 3441001,5701001 | Number of Individuals Covered | 1053 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $59,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 959 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of fees paid to insurance company | USD $31,983 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $541,209 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 31983 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-AD&D |
Policy instance | 5 |
Insurance contract or identification number | 0885565-AD&D | Number of Individuals Covered | 587 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $12,976 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DISABIL |
Policy instance | 7 |
Insurance contract or identification number | 0885565-DISABIL | Number of Individuals Covered | 376 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,033 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-TDI |
Policy instance | 8 |
Insurance contract or identification number | 0885565-TDI | Number of Individuals Covered | 1544 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $227,833 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 9 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 83 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $21,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 908285 |
Policy instance | 10 |
Insurance contract or identification number | 908285 | Number of Individuals Covered | 106 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Other welfare benefits provided | BTM | Welfare Benefit Premiums Paid to Carrier | USD $4,127 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | ADD N10846298 |
Policy instance | 11 |
Insurance contract or identification number | ADD N10846298 | Number of Individuals Covered | 1043 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Other welfare benefits provided | BTA | Welfare Benefit Premiums Paid to Carrier | USD $7,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0173632 |
Policy instance | 12 |
Insurance contract or identification number | 0173632 | Number of Individuals Covered | 319 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $7,492 | Total amount of fees paid to insurance company | USD $587 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,227 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,492 | Amount paid for insurance broker fees | 587 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0173631 |
Policy instance | 13 |
Insurance contract or identification number | 0173631 | Number of Individuals Covered | 117 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $9,534 | Total amount of fees paid to insurance company | USD $739 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,640 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,534 | Amount paid for insurance broker fees | 739 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 9 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 75 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $22,174 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 908285 |
Policy instance | 10 |
Insurance contract or identification number | 908285 | Number of Individuals Covered | 106 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Other welfare benefits provided | BTM | Welfare Benefit Premiums Paid to Carrier | USD $4,127 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | ADD N10846298 |
Policy instance | 11 |
Insurance contract or identification number | ADD N10846298 | Number of Individuals Covered | 1043 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Other welfare benefits provided | BTA | Welfare Benefit Premiums Paid to Carrier | USD $7,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0173632 |
Policy instance | 12 |
Insurance contract or identification number | 0173632 | Number of Individuals Covered | 327 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,770 | Total amount of fees paid to insurance company | USD $806 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,451 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,770 | Amount paid for insurance broker fees | 806 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0173631 |
Policy instance | 13 |
Insurance contract or identification number | 0173631 | Number of Individuals Covered | 240 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $8,580 | Total amount of fees paid to insurance company | USD $953 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,558 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,580 | Amount paid for insurance broker fees | 953 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-TDI |
Policy instance | 8 |
Insurance contract or identification number | 0885565-TDI | Number of Individuals Covered | 1608 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $239,840 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DISABIL |
Policy instance | 7 |
Insurance contract or identification number | 0885565-DISABIL | Number of Individuals Covered | 369 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $58,016 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 1148 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of fees paid to insurance company | USD $23,293 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $527,945 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 23293 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97053441001 |
Policy instance | 2 |
Insurance contract or identification number | 97053441001 | Number of Individuals Covered | 1177 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,843 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 35 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $183,073 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 105 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $452,669 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-AD&D |
Policy instance | 5 |
Insurance contract or identification number | 0885565-AD&D | Number of Individuals Covered | 643 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $10,325 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DEATH |
Policy instance | 6 |
Insurance contract or identification number | 0885565-DEATH | Number of Individuals Covered | 1420 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $224,913 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 1104 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of fees paid to insurance company | USD $18,543 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $458,682 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 18543 | Additional information about fees paid to insurance broker | SERVICE/SEN. AGENT FEES | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97053441001 |
Policy instance | 2 |
Insurance contract or identification number | 97053441001 | Number of Individuals Covered | 1039 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,467 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 38 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $185,615 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 85 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $374,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-AD&D |
Policy instance | 5 |
Insurance contract or identification number | 0885565-AD&D | Number of Individuals Covered | 675 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,684 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DEATH |
Policy instance | 6 |
Insurance contract or identification number | 0885565-DEATH | Number of Individuals Covered | 1382 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $205,013 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DISABIL |
Policy instance | 7 |
Insurance contract or identification number | 0885565-DISABIL | Number of Individuals Covered | 356 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $51,780 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-TDI |
Policy instance | 8 |
Insurance contract or identification number | 0885565-TDI | Number of Individuals Covered | 1592 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $188,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 908285 |
Policy instance | 10 |
Insurance contract or identification number | 908285 | Number of Individuals Covered | 690 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Other welfare benefits provided | BTM | Welfare Benefit Premiums Paid to Carrier | USD $4,127 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 9 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 67 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $16,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | ADD N10846298 |
Policy instance | 11 |
Insurance contract or identification number | ADD N10846298 | Number of Individuals Covered | 690 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0173632 |
Policy instance | 12 |
Insurance contract or identification number | 0173632 | Number of Individuals Covered | 311 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $5,692 | Total amount of fees paid to insurance company | USD $541 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,235 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,692 | Amount paid for insurance broker fees | 541 | Additional information about fees paid to insurance broker | NON-MONETARY/SUPPLEMENTAL COMP. ADMIN FEES | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0173631 |
Policy instance | 13 |
Insurance contract or identification number | 0173631 | Number of Individuals Covered | 193 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $7,622 | Total amount of fees paid to insurance company | USD $708 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,622 | Amount paid for insurance broker fees | 708 | Additional information about fees paid to insurance broker | NON-MONEATRY/SUPPLEMENTAL COMP. ADMIN FEES | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-AD&D |
Policy instance | 6 |
Insurance contract or identification number | 0885565-AD&D | Number of Individuals Covered | 560 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,673 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 5 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 533 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $152,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 4 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 86 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $345,684 | 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 number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 44 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $186,166 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9705344 |
Policy instance | 2 |
Insurance contract or identification number | 9705344 | Number of Individuals Covered | 1473 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $60,696 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 2161 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | PREPAID DENTAL | Welfare Benefit Premiums Paid to Carrier | USD $853,995 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DEATH |
Policy instance | 7 |
Insurance contract or identification number | 0885565-DEATH | Number of Individuals Covered | 2225 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of fees paid to insurance company | USD $2,735 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $313,113 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2735 | Additional information about fees paid to insurance broker | 2014/2015 PPP ENGAGEMENT CREDIT | Insurance broker organization code? | 3 | Insurance broker name | THE PLEXUS GROUPE LLC |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-TDI |
Policy instance | 9 |
Insurance contract or identification number | 0885565-TDI | Number of Individuals Covered | 2096 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of fees paid to insurance company | USD $18 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $324,748 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 18 | Additional information about fees paid to insurance broker | 2014/2015 PPP ENGAGEMENT CREDIT | Insurance broker organization code? | 3 | Insurance broker name | THE PLEXUS GROUPE LLC |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 571353 |
Policy instance | 10 |
Insurance contract or identification number | 571353 | Number of Individuals Covered | 101 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $21,794 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0885565-DISABIL |
Policy instance | 8 |
Insurance contract or identification number | 0885565-DISABIL | Number of Individuals Covered | 747 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $61,385 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 3 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 90 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $471,033 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9705344 |
Policy instance | 4 |
Insurance contract or identification number | 9705344 | Number of Individuals Covered | 1664 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,101 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3337481 |
Policy instance | 1 |
Insurance contract or identification number | 3337481 | Number of Individuals Covered | 1025 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Welfare Benefit Premiums Paid to Carrier | USD $746,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 2 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 39 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $191,087 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 1 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 43 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $156,747 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 2 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 77 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $285,851 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9705344 |
Policy instance | 4 |
Insurance contract or identification number | 9705344 | Number of Individuals Covered | 1957 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $68,540 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 226737 |
Policy instance | 3 |
Insurance contract or identification number | 226737 | Number of Individuals Covered | 1089 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $644,319 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 1 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 39 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $153,588 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226635 |
Policy instance | 3 |
Insurance contract or identification number | 226635 | Number of Individuals Covered | 80 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $369,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9705344 |
Policy instance | 2 |
Insurance contract or identification number | 9705344 | Number of Individuals Covered | 2244 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $73,791 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 41 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Welfare Benefit Premiums Paid to Carrier | USD $152,091 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 2 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 91 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Welfare Benefit Premiums Paid to Carrier | USD $344,254 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 202878 |
Policy instance | 1 |
Insurance contract or identification number | 202878 | Number of Individuals Covered | 1159 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of fees paid to insurance company | USD $33,768 | Welfare Benefit Premiums Paid to Carrier | USD $675,370 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 2 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 37 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Welfare Benefit Premiums Paid to Carrier | USD $178,129 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 202878 |
Policy instance | 1 |
Insurance contract or identification number | 202878 | Number of Individuals Covered | 1028 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $29,499 | Welfare Benefit Premiums Paid to Carrier | USD $737,483 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 30429 |
Policy instance | 3 |
Insurance contract or identification number | 30429 | Number of Individuals Covered | 16 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Welfare Benefit Premiums Paid to Carrier | USD $178,129 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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