FUJITSU NORTH AMERICA, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FUJITSU GROUP WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022 : FUJITSU GROUP WELFARE BENEFIT PLAN 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $2,973,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $2,507,000 |
| Total income from all sources (including contributions) | 2022-12-31 | $29,597,331 |
| Total of all expenses incurred | 2022-12-31 | $31,258,954 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $29,344,516 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $29,597,052 |
| Value of total assets at end of year | 2022-12-31 | $4,376,997 |
| Value of total assets at beginning of year | 2022-12-31 | $5,572,620 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $1,914,438 |
| Total interest from all sources | 2022-12-31 | $279 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $159,108 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $7,623,471 |
| Participant contributions at end of year | 2022-12-31 | $21,062 |
| Participant contributions at beginning of year | 2022-12-31 | $40,409 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2022-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $422,129 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $23 |
| Administrative expenses (other) incurred | 2022-12-31 | $73,805 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Income. Non cash contributions | 2022-12-31 | $0 |
| Value of net income/loss | 2022-12-31 | $-1,661,623 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $1,403,997 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $3,065,620 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $0 |
| Interest on participant loans | 2022-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2022-12-31 | $0 |
| Interest earned on other investments | 2022-12-31 | $0 |
| Income. Interest from US Government securities | 2022-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2022-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $3,228,355 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $5,370,964 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $5,370,964 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $279 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $2,314,219 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $21,973,581 |
| Employer contributions (assets) at end of year | 2022-12-31 | $705,451 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $161,224 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $27,030,297 |
| Contract administrator fees | 2022-12-31 | $1,681,525 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $2,973,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $2,507,000 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2022-12-31 | 910189318 |
| 2021 : FUJITSU GROUP WELFARE BENEFIT PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $2,507,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $3,279,768 |
| Total income from all sources (including contributions) | 2021-12-31 | $34,583,416 |
| Total of all expenses incurred | 2021-12-31 | $34,020,170 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $31,102,535 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $34,583,074 |
| Value of total assets at end of year | 2021-12-31 | $5,572,620 |
| Value of total assets at beginning of year | 2021-12-31 | $5,782,142 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $2,917,635 |
| Total interest from all sources | 2021-12-31 | $342 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $167,672 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $8,578,948 |
| Participant contributions at end of year | 2021-12-31 | $40,409 |
| Participant contributions at beginning of year | 2021-12-31 | $61,762 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $23 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $26 |
| Administrative expenses (other) incurred | 2021-12-31 | $121,625 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $2,768 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Income. Non cash contributions | 2021-12-31 | $0 |
| Value of net income/loss | 2021-12-31 | $563,246 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $3,065,620 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $2,502,374 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $5,370,964 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $5,602,345 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $5,602,345 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $342 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $1,770,521 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $26,004,126 |
| Employer contributions (assets) at end of year | 2021-12-31 | $161,224 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $118,009 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $29,332,014 |
| Contract administrator fees | 2021-12-31 | $2,628,338 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $2,507,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $3,277,000 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2021-12-31 | 910189318 |
| 2020 : FUJITSU GROUP WELFARE BENEFIT PLAN 2020 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2020-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2020-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $3,279,768 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $4,086,000 |
| Expenses. Interest paid | 2020-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2020-12-31 | $0 |
| Total income from all sources (including contributions) | 2020-12-31 | $41,166,601 |
| Total loss/gain on sale of assets | 2020-12-31 | $0 |
| Total of all expenses incurred | 2020-12-31 | $36,010,619 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $32,635,347 |
| Expenses. Certain deemed distributions of participant loans | 2020-12-31 | $0 |
| Value of total corrective distributions | 2020-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $41,161,757 |
| Value of total assets at end of year | 2020-12-31 | $5,782,142 |
| Value of total assets at beginning of year | 2020-12-31 | $1,432,392 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $3,375,272 |
| Total income from rents | 2020-12-31 | $0 |
| Total interest from all sources | 2020-12-31 | $4,844 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2020-12-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2020-12-31 | $0 |
| Administrative expenses professional fees incurred | 2020-12-31 | $91,248 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2020-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2020-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $10,779,168 |
| Participant contributions at end of year | 2020-12-31 | $0 |
| Participant contributions at beginning of year | 2020-12-31 | $0 |
| Participant contributions at end of year | 2020-12-31 | $61,762 |
| Participant contributions at beginning of year | 2020-12-31 | $58,367 |
| Assets. Other investments not covered elsewhere at end of year | 2020-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2020-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $26 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $1,848 |
| Assets. Loans (other than to participants) at end of year | 2020-12-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2020-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $0 |
| Other income not declared elsewhere | 2020-12-31 | $0 |
| Administrative expenses (other) incurred | 2020-12-31 | $128,433 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $2,768 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $0 |
| Total non interest bearing cash at end of year | 2020-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Income. Non cash contributions | 2020-12-31 | $0 |
| Value of net income/loss | 2020-12-31 | $5,155,982 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $2,502,374 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-2,653,608 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2020-12-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2020-12-31 | $0 |
| Investment advisory and management fees | 2020-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $0 |
| Value of interest in pooled separate accounts at end of year | 2020-12-31 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2020-12-31 | $0 |
| Interest on participant loans | 2020-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2020-12-31 | $0 |
| Interest earned on other investments | 2020-12-31 | $0 |
| Income. Interest from US Government securities | 2020-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2020-12-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2020-12-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2020-12-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2020-12-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2020-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $5,602,345 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $1,338,724 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $1,338,724 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $4,844 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2020-12-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2020-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2020-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2020-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $2,346,166 |
| Asset value of US Government securities at end of year | 2020-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2020-12-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2020-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2020-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2020-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Assets. Invements in employer securities at end of year | 2020-12-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2020-12-31 | $0 |
| Assets. Value of employer real property at end of year | 2020-12-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2020-12-31 | $0 |
| Contributions received in cash from employer | 2020-12-31 | $30,382,589 |
| Employer contributions (assets) at end of year | 2020-12-31 | $118,009 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $33,453 |
| Income. Dividends from preferred stock | 2020-12-31 | $0 |
| Income. Dividends from common stock | 2020-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $30,289,181 |
| Asset. Corporate debt instrument preferred debt at end of year | 2020-12-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2020-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2020-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2020-12-31 | $0 |
| Contract administrator fees | 2020-12-31 | $3,155,591 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2020-12-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2020-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $3,277,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $4,086,000 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2020-12-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2020-12-31 | $0 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Aggregate proceeds on sale of assets | 2020-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2020-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2020-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2020-12-31 | $0 |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2020-12-31 | 910189318 |
| 2019 : FUJITSU GROUP WELFARE BENEFIT PLAN 2019 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2019-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2019-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $4,086,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $3,715,000 |
| Expenses. Interest paid | 2019-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2019-12-31 | $0 |
| Total income from all sources (including contributions) | 2019-12-31 | $42,540,582 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total of all expenses incurred | 2019-12-31 | $45,670,023 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $41,801,002 |
| Expenses. Certain deemed distributions of participant loans | 2019-12-31 | $0 |
| Value of total corrective distributions | 2019-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $42,488,644 |
| Value of total assets at end of year | 2019-12-31 | $1,432,392 |
| Value of total assets at beginning of year | 2019-12-31 | $4,190,833 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $3,869,021 |
| Total income from rents | 2019-12-31 | $0 |
| Total interest from all sources | 2019-12-31 | $51,938 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2019-12-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2019-12-31 | $0 |
| Administrative expenses professional fees incurred | 2019-12-31 | $273,487 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2019-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2019-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $11,902,460 |
| Participant contributions at end of year | 2019-12-31 | $0 |
| Participant contributions at beginning of year | 2019-12-31 | $0 |
| Participant contributions at end of year | 2019-12-31 | $58,367 |
| Participant contributions at beginning of year | 2019-12-31 | $122,290 |
| Assets. Other investments not covered elsewhere at end of year | 2019-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2019-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $1,848 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $5,701 |
| Assets. Loans (other than to participants) at end of year | 2019-12-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2019-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $0 |
| Other income not declared elsewhere | 2019-12-31 | $0 |
| Administrative expenses (other) incurred | 2019-12-31 | $242,232 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $0 |
| Total non interest bearing cash at end of year | 2019-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Income. Non cash contributions | 2019-12-31 | $0 |
| Value of net income/loss | 2019-12-31 | $-3,129,441 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $-2,653,608 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $475,833 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2019-12-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2019-12-31 | $0 |
| Investment advisory and management fees | 2019-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $0 |
| Value of interest in pooled separate accounts at end of year | 2019-12-31 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2019-12-31 | $0 |
| Interest on participant loans | 2019-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2019-12-31 | $0 |
| Interest earned on other investments | 2019-12-31 | $0 |
| Income. Interest from US Government securities | 2019-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2019-12-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2019-12-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2019-12-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2019-12-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2019-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $1,338,724 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $3,974,556 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $3,974,556 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $51,938 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2019-12-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2019-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2019-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2019-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,275,262 |
| Asset value of US Government securities at end of year | 2019-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2019-12-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2019-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2019-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2019-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Assets. Invements in employer securities at end of year | 2019-12-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2019-12-31 | $0 |
| Assets. Value of employer real property at end of year | 2019-12-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2019-12-31 | $0 |
| Contributions received in cash from employer | 2019-12-31 | $30,586,184 |
| Employer contributions (assets) at end of year | 2019-12-31 | $33,453 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $88,286 |
| Income. Dividends from preferred stock | 2019-12-31 | $0 |
| Income. Dividends from common stock | 2019-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $39,525,740 |
| Asset. Corporate debt instrument preferred debt at end of year | 2019-12-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2019-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2019-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2019-12-31 | $0 |
| Contract administrator fees | 2019-12-31 | $3,353,302 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2019-12-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2019-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $4,086,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $3,715,000 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2019-12-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2019-12-31 | $0 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Aggregate proceeds on sale of assets | 2019-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2019-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2019-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2019-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
| Accountancy firm name | 2019-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2019-12-31 | 910189318 |
| 2018 : FUJITSU GROUP WELFARE BENEFIT PLAN 2018 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2018-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2018-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $0 |
| Total transfer of assets to this plan | 2018-12-31 | $0 |
| Total transfer of assets from this plan | 2018-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $3,715,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $6,158,953 |
| Expenses. Interest paid | 2018-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2018-12-31 | $0 |
| Total income from all sources (including contributions) | 2018-12-31 | $48,432,658 |
| Total loss/gain on sale of assets | 2018-12-31 | $0 |
| Total of all expenses incurred | 2018-12-31 | $49,055,676 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $45,103,017 |
| Expenses. Certain deemed distributions of participant loans | 2018-12-31 | $0 |
| Value of total corrective distributions | 2018-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $48,373,745 |
| Value of total assets at end of year | 2018-12-31 | $4,190,833 |
| Value of total assets at beginning of year | 2018-12-31 | $7,257,804 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $3,952,659 |
| Total income from rents | 2018-12-31 | $0 |
| Total interest from all sources | 2018-12-31 | $58,913 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-12-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2018-12-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2018-12-31 | $0 |
| Administrative expenses professional fees incurred | 2018-12-31 | $154,842 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2018-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2018-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $14,140,214 |
| Participant contributions at end of year | 2018-12-31 | $0 |
| Participant contributions at beginning of year | 2018-12-31 | $0 |
| Participant contributions at end of year | 2018-12-31 | $122,290 |
| Participant contributions at beginning of year | 2018-12-31 | $58,839 |
| Assets. Other investments not covered elsewhere at end of year | 2018-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2018-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $5,701 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $3,599 |
| Assets. Loans (other than to participants) at end of year | 2018-12-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2018-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $0 |
| Other income not declared elsewhere | 2018-12-31 | $0 |
| Administrative expenses (other) incurred | 2018-12-31 | $160,097 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $2,095,953 |
| Total non interest bearing cash at end of year | 2018-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Income. Non cash contributions | 2018-12-31 | $0 |
| Value of net income/loss | 2018-12-31 | $-623,018 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $475,833 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $1,098,851 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2018-12-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2018-12-31 | $0 |
| Investment advisory and management fees | 2018-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-12-31 | $0 |
| Value of interest in pooled separate accounts at end of year | 2018-12-31 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2018-12-31 | $0 |
| Interest on participant loans | 2018-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2018-12-31 | $0 |
| Interest earned on other investments | 2018-12-31 | $0 |
| Income. Interest from US Government securities | 2018-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2018-12-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2018-12-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2018-12-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2018-12-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2018-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $3,974,556 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $7,065,420 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $7,065,420 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $58,913 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2018-12-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2018-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2018-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2018-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $2,438,508 |
| Asset value of US Government securities at end of year | 2018-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2018-12-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2018-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2018-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2018-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Assets. Invements in employer securities at end of year | 2018-12-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2018-12-31 | $0 |
| Assets. Value of employer real property at end of year | 2018-12-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2018-12-31 | $0 |
| Contributions received in cash from employer | 2018-12-31 | $34,233,531 |
| Employer contributions (assets) at end of year | 2018-12-31 | $88,286 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $129,946 |
| Income. Dividends from preferred stock | 2018-12-31 | $0 |
| Income. Dividends from common stock | 2018-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $42,664,509 |
| Asset. Corporate debt instrument preferred debt at end of year | 2018-12-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2018-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2018-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2018-12-31 | $0 |
| Contract administrator fees | 2018-12-31 | $3,637,720 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2018-12-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2018-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $3,715,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $4,063,000 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-12-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-12-31 | $0 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Aggregate proceeds on sale of assets | 2018-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2018-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2018-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2018-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Disclaimer |
| Accountancy firm name | 2018-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2018-12-31 | 910189318 |
| 2017 : FUJITSU GROUP WELFARE BENEFIT PLAN 2017 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2017-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2017-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $0 |
| Total transfer of assets to this plan | 2017-12-31 | $0 |
| Total transfer of assets from this plan | 2017-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $6,158,953 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $5,916,590 |
| Expenses. Interest paid | 2017-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2017-12-31 | $0 |
| Total income from all sources (including contributions) | 2017-12-31 | $57,715,741 |
| Total loss/gain on sale of assets | 2017-12-31 | $0 |
| Total of all expenses incurred | 2017-12-31 | $53,662,454 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $47,530,710 |
| Expenses. Certain deemed distributions of participant loans | 2017-12-31 | $0 |
| Value of total corrective distributions | 2017-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $57,690,713 |
| Value of total assets at end of year | 2017-12-31 | $7,257,804 |
| Value of total assets at beginning of year | 2017-12-31 | $2,962,154 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $6,131,744 |
| Total income from rents | 2017-12-31 | $0 |
| Total interest from all sources | 2017-12-31 | $25,028 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-12-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2017-12-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2017-12-31 | $0 |
| Administrative expenses professional fees incurred | 2017-12-31 | $310,430 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2017-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2017-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $16,241,598 |
| Participant contributions at end of year | 2017-12-31 | $0 |
| Participant contributions at beginning of year | 2017-12-31 | $0 |
| Participant contributions at end of year | 2017-12-31 | $58,839 |
| Participant contributions at beginning of year | 2017-12-31 | $34,456 |
| Assets. Other investments not covered elsewhere at end of year | 2017-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2017-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $3,599 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $619 |
| Assets. Loans (other than to participants) at end of year | 2017-12-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2017-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $0 |
| Other income not declared elsewhere | 2017-12-31 | $0 |
| Administrative expenses (other) incurred | 2017-12-31 | $580,212 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $2,095,953 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $36,590 |
| Total non interest bearing cash at end of year | 2017-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Income. Non cash contributions | 2017-12-31 | $0 |
| Value of net income/loss | 2017-12-31 | $4,053,287 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $1,098,851 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-2,954,436 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2017-12-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2017-12-31 | $0 |
| Investment advisory and management fees | 2017-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-12-31 | $0 |
| Value of interest in pooled separate accounts at end of year | 2017-12-31 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2017-12-31 | $0 |
| Interest on participant loans | 2017-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2017-12-31 | $0 |
| Interest earned on other investments | 2017-12-31 | $0 |
| Income. Interest from US Government securities | 2017-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2017-12-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2017-12-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2017-12-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2017-12-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2017-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $7,065,420 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $2,888,685 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $2,888,685 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-12-31 | $25,028 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2017-12-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2017-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2017-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2017-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $2,430,895 |
| Asset value of US Government securities at end of year | 2017-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2017-12-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2017-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2017-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2017-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Assets. Invements in employer securities at end of year | 2017-12-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2017-12-31 | $0 |
| Assets. Value of employer real property at end of year | 2017-12-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2017-12-31 | $0 |
| Contributions received in cash from employer | 2017-12-31 | $41,449,115 |
| Employer contributions (assets) at end of year | 2017-12-31 | $129,946 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $38,394 |
| Income. Dividends from preferred stock | 2017-12-31 | $0 |
| Income. Dividends from common stock | 2017-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $45,099,815 |
| Asset. Corporate debt instrument preferred debt at end of year | 2017-12-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2017-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2017-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2017-12-31 | $0 |
| Contract administrator fees | 2017-12-31 | $5,241,102 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2017-12-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2017-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $4,063,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $5,880,000 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2017-12-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2017-12-31 | $0 |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Aggregate proceeds on sale of assets | 2017-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2017-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2017-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2017-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Disclaimer |
| Accountancy firm name | 2017-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2017-12-31 | 910189318 |
| 2016 : FUJITSU GROUP WELFARE BENEFIT PLAN 2016 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2016-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2016-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total transfer of assets to this plan | 2016-12-31 | $0 |
| Total transfer of assets from this plan | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $5,916,590 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $7,929,759 |
| Expenses. Interest paid | 2016-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2016-12-31 | $0 |
| Total income from all sources (including contributions) | 2016-12-31 | $62,840,735 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $59,187,730 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $55,026,615 |
| Expenses. Certain deemed distributions of participant loans | 2016-12-31 | $0 |
| Value of total corrective distributions | 2016-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $62,835,903 |
| Value of total assets at end of year | 2016-12-31 | $2,962,154 |
| Value of total assets at beginning of year | 2016-12-31 | $1,322,318 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $4,161,115 |
| Total income from rents | 2016-12-31 | $0 |
| Total interest from all sources | 2016-12-31 | $4,832 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $0 |
| Administrative expenses professional fees incurred | 2016-12-31 | $103,618 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $16,897,590 |
| Participant contributions at end of year | 2016-12-31 | $34,456 |
| Participant contributions at beginning of year | 2016-12-31 | $44,358 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $619 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $123 |
| Other income not declared elsewhere | 2016-12-31 | $0 |
| Administrative expenses (other) incurred | 2016-12-31 | $412,919 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $36,590 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $173,615 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Income. Non cash contributions | 2016-12-31 | $0 |
| Value of net income/loss | 2016-12-31 | $3,653,005 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $-2,954,436 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $-6,607,441 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Investment advisory and management fees | 2016-12-31 | $0 |
| Interest on participant loans | 2016-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2016-12-31 | $0 |
| Interest earned on other investments | 2016-12-31 | $0 |
| Income. Interest from US Government securities | 2016-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2016-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $2,888,685 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $1,236,813 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $1,236,813 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $4,832 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $3,045,220 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2016-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2016-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2016-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $45,938,313 |
| Employer contributions (assets) at end of year | 2016-12-31 | $38,394 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $41,024 |
| Income. Dividends from preferred stock | 2016-12-31 | $0 |
| Income. Dividends from common stock | 2016-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $51,981,395 |
| Contract administrator fees | 2016-12-31 | $3,644,578 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $5,880,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $7,756,144 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Aggregate proceeds on sale of assets | 2016-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2016-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
| Accountancy firm name | 2016-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2016-12-31 | 910189318 |
| 2015 : FUJITSU GROUP WELFARE BENEFIT PLAN 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $7,929,759 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $7,703,891 |
| Total income from all sources (including contributions) | 2015-12-31 | $64,602,279 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $66,536,573 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $61,915,055 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $64,600,768 |
| Value of total assets at end of year | 2015-12-31 | $1,322,318 |
| Value of total assets at beginning of year | 2015-12-31 | $3,030,744 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $4,621,518 |
| Total interest from all sources | 2015-12-31 | $1,511 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $14,724,766 |
| Participant contributions at end of year | 2015-12-31 | $44,358 |
| Participant contributions at beginning of year | 2015-12-31 | $68,307 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $123 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $190 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $173,615 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $103,625 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-1,934,294 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $-6,607,441 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $-4,673,147 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $1,236,813 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $2,915,300 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $2,915,300 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $1,511 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $2,223,788 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $49,876,002 |
| Employer contributions (assets) at end of year | 2015-12-31 | $41,024 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $46,947 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $59,691,267 |
| Contract administrator fees | 2015-12-31 | $4,621,518 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $7,756,144 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $7,600,266 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
| Accountancy firm name | 2015-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2015-12-31 | 910189318 |
| 2014 : FUJITSU GROUP WELFARE BENEFIT PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $7,703,891 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $7,019,170 |
| Total income from all sources (including contributions) | 2014-12-31 | $59,674,742 |
| Total loss/gain on sale of assets | 2014-12-31 | $0 |
| Total of all expenses incurred | 2014-12-31 | $61,446,577 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $56,764,342 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $59,671,873 |
| Value of total assets at end of year | 2014-12-31 | $3,030,744 |
| Value of total assets at beginning of year | 2014-12-31 | $4,117,858 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $4,682,235 |
| Total interest from all sources | 2014-12-31 | $2,869 |
| 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 year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $14,329,844 |
| Participant contributions at end of year | 2014-12-31 | $68,307 |
| Participant contributions at beginning of year | 2014-12-31 | $67,009 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $190 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $254 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $103,625 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $146,009 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-1,771,835 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $-4,673,147 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $-2,901,312 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $2,915,300 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $4,036,228 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $4,036,228 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $2,869 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $2,017,743 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $45,342,029 |
| Employer contributions (assets) at end of year | 2014-12-31 | $46,947 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $14,367 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $54,746,599 |
| Contract administrator fees | 2014-12-31 | $4,682,235 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $7,600,266 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $6,873,161 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2014-12-31 | 910189318 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8189 |
| Policy instance | 5 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 155 | | 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 | 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 $873,404 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $544 | | 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 | 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 $15,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $544 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 116466 |
| Policy instance | 3 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 34 | | 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 | 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 $20,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 2 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 4 | | 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 | 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 $23,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 174002 |
| Policy instance | 1 |
| Insurance contract or identification number | 174002 | | Number of Individuals Covered | 4206 | | 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 | 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 $108,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL36992 |
| Policy instance | 6 |
| Insurance contract or identification number | HCL36992 | | Number of Individuals Covered | 1663 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $21,212 | | 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 | | 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 $848,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,212 | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 174002 |
| Policy instance | 1 |
| Insurance contract or identification number | 174002 | | Number of Individuals Covered | 4541 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7,907 | | 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 $1,018,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7907 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 2 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 | 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 $28,949 | | 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 | 116466 |
| Policy instance | 3 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 | 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 $178,747 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $227 | | 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 | 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 $5,126 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $227 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8189 |
| Policy instance | 5 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 | 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 $1,252,658 | | 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 | 8189 |
| Policy instance | 5 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | 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 $1,759,616 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $522 | | 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 | 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 $16,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $522 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 116466 |
| Policy instance | 3 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | 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 $529,533 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 2 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | 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 $37,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 174002 |
| Policy instance | 1 |
| Insurance contract or identification number | 174002 | | Number of Individuals Covered | 2361 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | 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 $975,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 174002 |
| Policy instance | 1 |
| Insurance contract or identification number | 174002 | | Number of Individuals Covered | 2634 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $67,262 | | 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 | 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 $925,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,262 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8189 |
| Policy instance | 5 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 | 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 $1,767,303 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $111 | | 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 | 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 $9,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 116466 |
| Policy instance | 3 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 | 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 $453,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 2 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 | 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 $51,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 2 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | 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 $46,813 | | 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 | 116466 |
| Policy instance | 3 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | 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 $503,053 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $135 | | 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 | 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 $14,768 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8189 |
| Policy instance | 5 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 345 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | 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 $1,938,766 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 174002 |
| Policy instance | 1 |
| Insurance contract or identification number | 174002 | | Number of Individuals Covered | 2905 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | 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 $896,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 174002 |
| Policy instance | 1 |
| Insurance contract or identification number | 174002 | | Number of Individuals Covered | 3506 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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? | 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 | | 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 $832,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 2 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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? | 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 $67,538 | | 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 | 116466 |
| Policy instance | 3 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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? | 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 $374,198 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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? | 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 $8,738 | | 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 | 8189 |
| Policy instance | 5 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 344 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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? | 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 $1,918,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 1 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | 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 $57,759 | | 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 | 116466 |
| Policy instance | 2 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $318,394 | | 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 | 13814 |
| Policy instance | 3 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $17,833 | | 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 | 8189 |
| Policy instance | 4 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $1,703,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FJSU0 |
| Policy instance | 5 |
| Insurance contract or identification number | FJSU0 | | Number of Individuals Covered | 4349 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | EMPLOYEE ASSISTANCE PROGRAM | | 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 $92,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FJSU0 |
| Policy instance | 5 |
| Insurance contract or identification number | FJSU0 | | Number of Individuals Covered | 4658 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | 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 $94,970 | | 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 | 13814 |
| Policy instance | 4 |
| Insurance contract or identification number | 13814 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 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 $15,957 | | 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 | 8189 |
| Policy instance | 3 |
| Insurance contract or identification number | 8189 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 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 $1,501,889 | | 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 | 116466 |
| Policy instance | 2 |
| Insurance contract or identification number | 116466 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 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 $326,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
| Policy contract number | 74987 |
| Policy instance | 1 |
| Insurance contract or identification number | 74987 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 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 $87,577 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
