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KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 401k Plan overview

Plan NameKEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES
Plan identification number 512

KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES Benefits

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

401k Sponsoring company profile

KEYSIGHT TECHNOLOGIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:KEYSIGHT TECHNOLOGIES, INC.
Employer identification number (EIN):464254555
NAIC Classification:334500

Additional information about KEYSIGHT TECHNOLOGIES, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2014-02-18
Company Identification Number: 0801936239
Legal Registered Office Address: 1400 FOUNTAINGROVE PKWY

SANTA ROSA
United States of America (USA)
95403

More information about KEYSIGHT TECHNOLOGIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5122022-01-01
5122021-01-01
5122020-01-01
5122019-01-01
5122018-01-01
5122017-01-01MARTI WILMES
5122016-01-01MOJI SAAVEDRA
5122015-01-01MARTI WILMES
5122015-01-01
5122014-08-01MARTI WILMES MARTI WILMES2015-10-14

Plan Statistics for KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES

401k plan membership statisitcs for KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES

Measure Date Value
2022: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2022 401k membership
Total participants, beginning-of-year2022-01-0190
Number of retired or separated participants receiving benefits2022-01-0173
Total of all active and inactive participants2022-01-0173
2021: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2021 401k membership
Total participants, beginning-of-year2021-01-01124
Number of retired or separated participants receiving benefits2021-01-0190
Total of all active and inactive participants2021-01-0190
2020: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2020 401k membership
Total participants, beginning-of-year2020-01-01170
Number of retired or separated participants receiving benefits2020-01-01134
Total of all active and inactive participants2020-01-01134
2019: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2019 401k membership
Total participants, beginning-of-year2019-01-01255
Number of retired or separated participants receiving benefits2019-01-01185
Total of all active and inactive participants2019-01-01185
2018: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2018 401k membership
Total participants, beginning-of-year2018-01-01323
Number of retired or separated participants receiving benefits2018-01-01262
Total of all active and inactive participants2018-01-01262
2017: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2017 401k membership
Total participants, beginning-of-year2017-01-01410
Number of retired or separated participants receiving benefits2017-01-01340
Total of all active and inactive participants2017-01-01340
2016: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2016 401k membership
Total participants, beginning-of-year2016-01-01535
Number of retired or separated participants receiving benefits2016-01-01430
Total of all active and inactive participants2016-01-01430
2015: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2015 401k membership
Total participants, beginning-of-year2015-01-01607
Number of retired or separated participants receiving benefits2015-01-01556
Total of all active and inactive participants2015-01-01556
2014: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2014 401k membership
Total participants, beginning-of-year2014-08-01712
Total number of active participants reported on line 7a of the Form 55002014-08-010
Number of retired or separated participants receiving benefits2014-08-01673
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01673

Financial Data on KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES

Measure Date Value
2022 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$1,059,561
Total of all expenses incurred2022-12-31$1,167,286
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,167,286
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,058,282
Value of total assets at end of year2022-12-31$73,013
Value of total assets at beginning of year2022-12-31$180,738
Total interest from all sources2022-12-31$1,279
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$15,000,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,058,282
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$254
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$7
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-107,725
Value of net assets at end of year (total assets less liabilities)2022-12-31$73,013
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$180,738
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Interest earned on other investments2022-12-31$1,279
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$72,759
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$180,731
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$180,731
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,167,286
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31MOSS ADAMS LLP
Accountancy firm EIN2022-12-31910189318
2021 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$1,446,532
Total of all expenses incurred2021-12-31$1,533,429
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,533,429
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,446,449
Value of total assets at end of year2021-12-31$180,738
Value of total assets at beginning of year2021-12-31$267,635
Total interest from all sources2021-12-31$83
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,446,449
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$7
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$14
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-86,897
Value of net assets at end of year (total assets less liabilities)2021-12-31$180,738
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$267,635
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Interest earned on other investments2021-12-31$83
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$180,731
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$267,621
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$267,621
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,533,429
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31MOSS ADAMS LLP
Accountancy firm EIN2021-12-31910189318
2020 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2020 401k financial data
Total income from all sources (including contributions)2020-12-31$1,949,395
Total of all expenses incurred2020-12-31$2,051,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$2,051,109
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,947,480
Value of total assets at end of year2020-12-31$267,635
Value of total assets at beginning of year2020-12-31$369,349
Total interest from all sources2020-12-31$1,915
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,947,480
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$14
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$515
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-101,714
Value of net assets at end of year (total assets less liabilities)2020-12-31$267,635
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$369,349
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Interest earned on other investments2020-12-31$1,915
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$267,621
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$368,834
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$368,834
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$2,051,109
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31MOSS ADAMS LLP
Accountancy firm EIN2020-12-31910189318
2019 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$2,648,649
Total of all expenses incurred2019-12-31$2,669,087
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$2,669,087
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$2,639,916
Value of total assets at end of year2019-12-31$369,349
Value of total assets at beginning of year2019-12-31$389,787
Total interest from all sources2019-12-31$8,733
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$2,639,916
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$515
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-20,438
Value of net assets at end of year (total assets less liabilities)2019-12-31$369,349
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$389,787
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Interest earned on other investments2019-12-31$8,733
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$368,834
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$389,787
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$389,787
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$2,669,087
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31MOSS ADAMS LLP
Accountancy firm EIN2019-12-31910189318
2018 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets2018-12-31$44
Total unrealized appreciation/depreciation of assets2018-12-31$44
Total income from all sources (including contributions)2018-12-31$2,947,570
Total of all expenses incurred2018-12-31$2,968,492
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$2,968,492
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$2,945,762
Value of total assets at end of year2018-12-31$389,787
Value of total assets at beginning of year2018-12-31$410,709
Total interest from all sources2018-12-31$1,764
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$2,945,762
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-20,922
Value of net assets at end of year (total assets less liabilities)2018-12-31$389,787
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$410,709
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Interest earned on other investments2018-12-31$1,764
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$389,787
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$410,709
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$410,709
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$2,968,492
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31MOSS ADAMS LLP
Accountancy firm EIN2018-12-31910189318
2017 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2017 401k financial data
Total income from all sources (including contributions)2017-12-31$3,030,611
Total of all expenses incurred2017-12-31$3,168,496
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$3,168,496
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$3,026,570
Value of total assets at end of year2017-12-31$410,709
Value of total assets at beginning of year2017-12-31$548,594
Total interest from all sources2017-12-31$4,041
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$3,026,570
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-137,885
Value of net assets at end of year (total assets less liabilities)2017-12-31$410,709
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$548,594
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Interest earned on other investments2017-12-31$4,041
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$410,709
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$548,594
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$548,594
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$3,168,496
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31MOSS ADAMS LLP
Accountancy firm EIN2017-12-31910189318
2016 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$3,838,540
Total of all expenses incurred2016-12-31$3,969,755
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$3,969,755
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$3,836,939
Value of total assets at end of year2016-12-31$548,594
Value of total assets at beginning of year2016-12-31$679,809
Total interest from all sources2016-12-31$1,601
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$3,836,939
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-131,215
Value of net assets at end of year (total assets less liabilities)2016-12-31$548,594
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$679,809
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Interest earned on other investments2016-12-31$1,601
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$548,594
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$679,809
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$679,809
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$3,969,755
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31MOSS ADAMS LLP
Accountancy firm EIN2016-12-31910189318
2015 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2015 401k financial data
Total income from all sources (including contributions)2015-12-31$4,075,174
Total of all expenses incurred2015-12-31$5,302,794
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$5,302,794
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$4,074,844
Value of total assets at end of year2015-12-31$679,809
Value of total assets at beginning of year2015-12-31$1,907,429
Total interest from all sources2015-12-31$330
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$15,000,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$4,074,844
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$412,401
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-1,227,620
Value of net assets at end of year (total assets less liabilities)2015-12-31$679,809
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$1,907,429
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Interest earned on other investments2015-12-31$330
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$679,809
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$1,907,429
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$1,907,429
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$4,890,393
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31MOSS ADAMS LLP
Accountancy firm EIN2015-12-31910189318
2014 : KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$1,907,429
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,907,353
Value of total assets at end of year2014-12-31$1,907,429
Value of total assets at beginning of year2014-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$0
Total interest from all sources2014-12-31$76
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$25,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,907,353
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$1,907,429
Value of net assets at end of year (total assets less liabilities)2014-12-31$1,907,429
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$1,907,429
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$76
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31MOSS ADAMS LLP
Accountancy firm EIN2014-12-31910189318

Form 5500 Responses for KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES

2022: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: KEYSIGHT TECHNOLOGIES, INC. HEALTH PLAN FOR RETIREES 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01First time form 5500 has been submittedYes
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan funding arrangement – TrustYes
2014-08-01Plan funding arrangement – General assets of the sponsorYes
2014-08-01Plan benefit arrangement – InsuranceYes
2014-08-01Plan benefit arrangement - TrustYes
2014-08-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 )
Policy contract number10605
Policy instance 6
Insurance contract or identification number10605
Number of Individuals Covered6
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $20,000
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,000
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number604364
Policy instance 5
Insurance contract or identification number604364
Number of Individuals Covered25
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,051
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $151,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,051
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231898
Policy instance 4
Insurance contract or identification number231898
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $117
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $117
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number7730
Policy instance 3
Insurance contract or identification number7730
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35629
Policy instance 2
Insurance contract or identification number35629
Number of Individuals Covered301
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,970,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4053200
Policy instance 1
Insurance contract or identification number4053200
Number of Individuals Covered6
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $255
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $255
Insurance broker organization code?4
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4053200
Policy instance 1
Insurance contract or identification number4053200
Number of Individuals Covered9
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $473
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $168,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $473
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35629
Policy instance 2
Insurance contract or identification number35629
Number of Individuals Covered271
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,920,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number7730
Policy instance 3
Insurance contract or identification number7730
Number of Individuals Covered9
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231898
Policy instance 4
Insurance contract or identification number231898
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $163
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $163
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number604364
Policy instance 5
Insurance contract or identification number604364
Number of Individuals Covered32
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,941
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $504,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,941
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number604364
Policy instance 5
Insurance contract or identification number604364
Number of Individuals Covered51
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,394
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $592,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,394
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231898
Policy instance 4
Insurance contract or identification number231898
Number of Individuals Covered3
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $165
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $165
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number7730
Policy instance 3
Insurance contract or identification number7730
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35629
Policy instance 2
Insurance contract or identification number35629
Number of Individuals Covered255
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,577,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4053200
Policy instance 1
Insurance contract or identification number4053200
Number of Individuals Covered13
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $441
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $146,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $441
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number7730
Policy instance 3
Insurance contract or identification number7730
Number of Individuals Covered8
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4053200
Policy instance 1
Insurance contract or identification number4053200
Number of Individuals Covered30
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,109
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $296,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,109
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35629
Policy instance 2
Insurance contract or identification number35629
Number of Individuals Covered284
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,990,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231898
Policy instance 4
Insurance contract or identification number231898
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $168
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $168
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number604364
Policy instance 5
Insurance contract or identification number604364
Number of Individuals Covered59
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,979
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $793,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,979
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number604364
Policy instance 5
Insurance contract or identification number604364
Number of Individuals Covered78
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,747
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $955,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,747
Insurance broker organization code?4
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4053200
Policy instance 1
Insurance contract or identification number4053200
Number of Individuals Covered18
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $631
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $231,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $631
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35629
Policy instance 2
Insurance contract or identification number35629
Number of Individuals Covered286
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,098,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number7730
Policy instance 3
Insurance contract or identification number7730
Number of Individuals Covered4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,035
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 number231898
Policy instance 4
Insurance contract or identification number231898
Number of Individuals Covered4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $93
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number604364
Policy instance 5
Insurance contract or identification number604364
Number of Individuals Covered92
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,991
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,003,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,991
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231898
Policy instance 4
Insurance contract or identification number231898
Number of Individuals Covered44
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,095
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $257,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,095
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number7730
Policy instance 3
Insurance contract or identification number7730
Number of Individuals Covered3
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35629
Policy instance 2
Insurance contract or identification number35629
Number of Individuals Covered256
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,814,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4053200
Policy instance 1
Insurance contract or identification number4053200
Number of Individuals Covered30
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $923
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $295,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $923
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC

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