BOARD OF TRUSTEES, TEAMSTERS SANITATION INDUSTRY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TEAMSTERS SANITATION INDUSTRY TRUST FUND
| Measure | Date | Value |
|---|
| 2022 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $244,286 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $36,632 |
| Total income from all sources (including contributions) | 2022-12-31 | $47,762,719 |
| Total of all expenses incurred | 2022-12-31 | $48,498,503 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $47,223,797 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $47,762,719 |
| Value of total assets at end of year | 2022-12-31 | $584,029 |
| Value of total assets at beginning of year | 2022-12-31 | $1,112,159 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $1,274,706 |
| 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 | $414,615 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $98,620 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $4,416 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $16,697 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $34,113 |
| Administrative expenses (other) incurred | 2022-12-31 | $100,264 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $227,589 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $2,519 |
| Total non interest bearing cash at end of year | 2022-12-31 | $577,602 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $1,103,513 |
| 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 |
| Value of net income/loss | 2022-12-31 | $-735,784 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $339,743 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $1,075,527 |
| 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 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| 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 | $47,664,099 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $47,223,797 |
| Contract administrator fees | 2022-12-31 | $759,827 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2022-12-31 | $6,427 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2022-12-31 | $4,230 |
| Did the plan have assets held for investment | 2022-12-31 | No |
| 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 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2022-12-31 | 952036255 |
| 2021 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $36,632 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $1,004,715 |
| Total income from all sources (including contributions) | 2021-12-31 | $44,721,078 |
| Total of all expenses incurred | 2021-12-31 | $44,641,741 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $43,388,812 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $44,721,078 |
| Value of total assets at end of year | 2021-12-31 | $1,112,159 |
| Value of total assets at beginning of year | 2021-12-31 | $2,000,905 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $1,252,929 |
| 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 | $395,649 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $81,144 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $4,416 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $34,113 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $999,158 |
| Administrative expenses (other) incurred | 2021-12-31 | $86,077 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $2,519 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $5,557 |
| Total non interest bearing cash at end of year | 2021-12-31 | $1,103,513 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $1,993,944 |
| 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 |
| Value of net income/loss | 2021-12-31 | $79,337 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $1,075,527 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $996,190 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $43,388,812 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| 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 | $44,639,934 |
| Contract administrator fees | 2021-12-31 | $771,203 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2021-12-31 | $4,230 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2021-12-31 | $6,961 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| 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 | MILLER KAPLAN ARASE LLP |
| Accountancy firm EIN | 2021-12-31 | 952036255 |
| 2020 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $1,004,715 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $2,075,283 |
| Total income from all sources (including contributions) | 2020-12-31 | $42,237,491 |
| Total of all expenses incurred | 2020-12-31 | $42,125,727 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $40,889,287 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $42,237,491 |
| Value of total assets at end of year | 2020-12-31 | $2,000,905 |
| Value of total assets at beginning of year | 2020-12-31 | $2,959,709 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $1,236,440 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $79,834 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $72,187 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $999,158 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $2,059,006 |
| Administrative expenses (other) incurred | 2020-12-31 | $393,075 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $5,557 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $16,277 |
| Total non interest bearing cash at end of year | 2020-12-31 | $1,993,944 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $2,954,606 |
| 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 |
| Value of net income/loss | 2020-12-31 | $111,764 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $996,190 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $884,426 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $40,889,287 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| 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 |
| Contributions received in cash from employer | 2020-12-31 | $42,165,304 |
| Contract administrator fees | 2020-12-31 | $763,531 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2020-12-31 | $6,961 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2020-12-31 | $5,103 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| 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 |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2020-12-31 | 952036255 |
| 2019 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $2,075,283 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $2,140,010 |
| Total income from all sources (including contributions) | 2019-12-31 | $41,029,115 |
| Total of all expenses incurred | 2019-12-31 | $40,513,112 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $39,283,141 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $41,029,115 |
| Value of total assets at end of year | 2019-12-31 | $2,959,709 |
| Value of total assets at beginning of year | 2019-12-31 | $2,508,433 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,229,971 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $85,931 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $45,750 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $2,059,006 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $2,133,041 |
| Administrative expenses (other) incurred | 2019-12-31 | $401,958 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $16,277 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $6,969 |
| Total non interest bearing cash at end of year | 2019-12-31 | $2,954,606 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $2,505,109 |
| 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 |
| Value of net income/loss | 2019-12-31 | $516,003 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $884,426 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $368,423 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $39,283,141 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| 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 |
| Contributions received in cash from employer | 2019-12-31 | $40,983,365 |
| Contract administrator fees | 2019-12-31 | $742,082 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2019-12-31 | $5,103 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2019-12-31 | $3,324 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| 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 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2019-12-31 | 952036255 |
| 2018 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $2,140,010 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $1,771,668 |
| Total income from all sources (including contributions) | 2018-12-31 | $39,263,451 |
| Total of all expenses incurred | 2018-12-31 | $39,416,470 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $38,207,576 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $39,263,451 |
| Value of total assets at end of year | 2018-12-31 | $2,508,433 |
| Value of total assets at beginning of year | 2018-12-31 | $2,293,110 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $1,208,894 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $104,628 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $29,798 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $2,133,041 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $1,769,199 |
| Administrative expenses (other) incurred | 2018-12-31 | $382,725 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $6,969 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $2,469 |
| Total non interest bearing cash at end of year | 2018-12-31 | $2,505,109 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $2,290,834 |
| 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 |
| Value of net income/loss | 2018-12-31 | $-153,019 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $368,423 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $521,442 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $38,207,576 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| 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 |
| Contributions received in cash from employer | 2018-12-31 | $39,233,653 |
| Contract administrator fees | 2018-12-31 | $721,541 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-12-31 | $3,324 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-12-31 | $2,276 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| 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 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2018-12-31 | 952036255 |
| 2017 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $1,771,668 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $2,353,738 |
| Total income from all sources (including contributions) | 2017-12-31 | $38,817,996 |
| Total of all expenses incurred | 2017-12-31 | $39,305,615 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $38,203,261 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $38,817,996 |
| Value of total assets at end of year | 2017-12-31 | $2,293,110 |
| Value of total assets at beginning of year | 2017-12-31 | $3,362,799 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $1,102,354 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $90,224 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $30,919 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $28,766 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $1,769,199 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $2,344,794 |
| Administrative expenses (other) incurred | 2017-12-31 | $337,158 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $2,469 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $8,944 |
| Total non interest bearing cash at end of year | 2017-12-31 | $2,290,834 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $3,360,084 |
| 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 |
| Value of net income/loss | 2017-12-31 | $-487,619 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $521,442 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $1,009,061 |
| 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 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| 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 |
| Contributions received in cash from employer | 2017-12-31 | $38,758,311 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $38,203,261 |
| Contract administrator fees | 2017-12-31 | $674,972 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2017-12-31 | $2,276 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2017-12-31 | $2,715 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| 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 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2017-12-31 | 952036255 |
| 2016 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2016 401k financial data |
|---|
| Total transfer of assets to this plan | 2016-12-31 | $205,819 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $2,353,738 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $2,766,775 |
| Total income from all sources (including contributions) | 2016-12-31 | $35,503,815 |
| Total of all expenses incurred | 2016-12-31 | $35,359,509 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $34,355,230 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $35,503,815 |
| Value of total assets at end of year | 2016-12-31 | $3,362,799 |
| Value of total assets at beginning of year | 2016-12-31 | $3,425,711 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $1,004,279 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $75,837 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $17,968 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-12-31 | $2,344,794 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $2,758,061 |
| Administrative expenses (other) incurred | 2016-12-31 | $297,260 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $8,944 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $8,714 |
| Total non interest bearing cash at end of year | 2016-12-31 | $3,360,084 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $3,423,718 |
| 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 |
| Value of net income/loss | 2016-12-31 | $144,306 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $1,009,061 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $658,936 |
| 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 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| 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 | $35,485,847 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $34,355,230 |
| Contract administrator fees | 2016-12-31 | $631,182 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2016-12-31 | $2,715 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-12-31 | $1,993 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| 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 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2016-12-31 | 952036255 |
| 2015 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2015 401k financial data |
|---|
| Total transfer of assets to this plan | 2015-12-31 | $64,897 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $2,766,775 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $1,757,053 |
| Total income from all sources (including contributions) | 2015-12-31 | $33,521,125 |
| Total of all expenses incurred | 2015-12-31 | $33,297,061 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $32,303,225 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $33,521,125 |
| Value of total assets at end of year | 2015-12-31 | $3,425,711 |
| Value of total assets at beginning of year | 2015-12-31 | $2,127,028 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $993,836 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $88,059 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $51,493 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $2,758,061 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $1,755,657 |
| Administrative expenses (other) incurred | 2015-12-31 | $293,633 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $8,714 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $1,396 |
| Total non interest bearing cash at end of year | 2015-12-31 | $3,423,718 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $2,124,067 |
| 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 | $224,064 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $658,936 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $369,975 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $32,303,225 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| 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 | $33,469,632 |
| Contract administrator fees | 2015-12-31 | $612,144 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-12-31 | $1,993 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2015-12-31 | $2,961 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| 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 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2015-12-31 | 952036255 |
| 2014 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2014 401k financial data |
|---|
| Total transfer of assets to this plan | 2014-12-31 | $246,294 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $1,757,053 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $353,452 |
| Total income from all sources (including contributions) | 2014-12-31 | $25,375,693 |
| Total of all expenses incurred | 2014-12-31 | $25,194,688 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $24,416,837 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $25,375,693 |
| Value of total assets at end of year | 2014-12-31 | $2,127,028 |
| Value of total assets at beginning of year | 2014-12-31 | $296,128 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $777,851 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $104,415 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $60,275 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $2,548 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $1,755,657 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $289,547 |
| Administrative expenses (other) incurred | 2014-12-31 | $223,273 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $1,396 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $63,905 |
| Total non interest bearing cash at end of year | 2014-12-31 | $2,124,067 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $293,580 |
| 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 | $181,005 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $369,975 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $-57,324 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $24,416,837 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| 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 | $25,315,418 |
| Contract administrator fees | 2014-12-31 | $450,163 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2014-12-31 | $2,961 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2014-12-31 | $0 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| 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 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2014-12-31 | 952036255 |
| 2013 : TEAMSTERS SANITATION INDUSTRY TRUST FUND 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $353,452 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $0 |
| Total income from all sources (including contributions) | 2013-12-31 | $1,562,773 |
| Total of all expenses incurred | 2013-12-31 | $1,620,097 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $1,509,236 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $1,562,773 |
| Value of total assets at end of year | 2013-12-31 | $296,128 |
| Value of total assets at beginning of year | 2013-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $110,861 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $59,883 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $100,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $10,893 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $2,548 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $289,547 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $0 |
| Administrative expenses (other) incurred | 2013-12-31 | $20,021 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $63,905 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $0 |
| Total non interest bearing cash at end of year | 2013-12-31 | $293,580 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $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 | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-57,324 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $-57,324 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $1,509,236 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $1,551,880 |
| Contract administrator fees | 2013-12-31 | $30,957 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| 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 | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | MILLER KAPLAN ASASE LLP |
| Accountancy firm EIN | 2013-12-31 | 952036255 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876 |
| Policy instance | 10 |
| Insurance contract or identification number | 93876 | | Number of Individuals Covered | 2449 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $77,660 | | 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 | 231206 |
| Policy instance | 1 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 6529 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,940,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE 1 |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE 1 | | Number of Individuals Covered | 782 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100434 |
| Policy instance | 3 |
| Insurance contract or identification number | 100434 | | Number of Individuals Covered | 2878 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 4 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 7388 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $462,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LA814C*000 |
| Policy instance | 5 |
| Insurance contract or identification number | LA814C*000 | | Number of Individuals Covered | 2497 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | ACUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $70,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 436 |
| Policy instance | 6 |
| Insurance contract or identification number | 436 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $488,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0065310 |
| Policy instance | 7 |
| Insurance contract or identification number | W0065310 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,879,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 805411G |
| Policy instance | 8 |
| Insurance contract or identification number | 805411G | | Number of Individuals Covered | 2569 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,627 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN REINSURANCE COMPANY, LTD (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100499 |
| Policy instance | 9 |
| Insurance contract or identification number | 100499 | | Number of Individuals Covered | 3606 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | 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 | 231206 |
| Policy instance | 1 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 7083 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,908,592 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE 1 |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE 1 | | Number of Individuals Covered | 937 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100434 |
| Policy instance | 3 |
| Insurance contract or identification number | 100434 | | Number of Individuals Covered | 3087 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 4 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 8019 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $460,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LA814C*000 |
| Policy instance | 5 |
| Insurance contract or identification number | LA814C*000 | | Number of Individuals Covered | 2628 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | ACUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $87,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 436 |
| Policy instance | 6 |
| Insurance contract or identification number | 436 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $461,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0065310 |
| Policy instance | 7 |
| Insurance contract or identification number | W0065310 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,499,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 8835 |
| Policy instance | 8 |
| Insurance contract or identification number | 8835 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $486 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 805411G |
| Policy instance | 9 |
| Insurance contract or identification number | 805411G | | Number of Individuals Covered | 2569 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN REINSURANCE COMPANY, LTD (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100499 |
| Policy instance | 10 |
| Insurance contract or identification number | 100499 | | Number of Individuals Covered | 3846 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 4 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 8142 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $455,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100434 |
| Policy instance | 3 |
| Insurance contract or identification number | 100434 | | Number of Individuals Covered | 3185 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE 1 |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE 1 | | Number of Individuals Covered | 1110 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | 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 | 231206 |
| Policy instance | 1 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 7292 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,317,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LA814C*000 |
| Policy instance | 5 |
| Insurance contract or identification number | LA814C*000 | | Number of Individuals Covered | 2742 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Other welfare benefits provided | ACUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $82,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 436 |
| Policy instance | 6 |
| Insurance contract or identification number | 436 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $396,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0065310 |
| Policy instance | 7 |
| Insurance contract or identification number | W0065310 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,773,601 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 8835 |
| Policy instance | 8 |
| Insurance contract or identification number | 8835 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 866224 |
| Policy instance | 9 |
| Insurance contract or identification number | 866224 | | Number of Individuals Covered | 2623 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-07-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 805411G |
| Policy instance | 10 |
| Insurance contract or identification number | 805411G | | Number of Individuals Covered | 2602 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN REINSURANCE COMPANY, LTD (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100499 |
| Policy instance | 11 |
| Insurance contract or identification number | 100499 | | Number of Individuals Covered | 3747 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 436 |
| Policy instance | 6 |
| Insurance contract or identification number | 436 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $360,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0065310 |
| Policy instance | 7 |
| Insurance contract or identification number | W0065310 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,631,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 008835 |
| Policy instance | 8 |
| Insurance contract or identification number | 008835 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 866224 |
| Policy instance | 9 |
| Insurance contract or identification number | 866224 | | Number of Individuals Covered | 2661 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,646 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LA814C*000 |
| Policy instance | 5 |
| Insurance contract or identification number | LA814C*000 | | Number of Individuals Covered | 2841 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | ACUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $80,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 4 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 8532 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $462,155 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100434 |
| Policy instance | 3 |
| Insurance contract or identification number | 100434 | | Number of Individuals Covered | 3464 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,693,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 1131 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | 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 | 231206 |
| Policy instance | 1 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 7686 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,813,368 | | 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 | 231206 |
| Policy instance | 1 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 7864 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,813,293 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 906645 |
| Policy instance | 2 |
| Insurance contract or identification number | 906645 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,018,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | * FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | * FOOTNOTE | | Number of Individuals Covered | 637 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | FOOTNOTE |
| Policy instance | 4 |
| Insurance contract or identification number | FOOTNOTE | | Number of Individuals Covered | 3348 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100434 |
| Policy instance | 5 |
| Insurance contract or identification number | 100434 | | Number of Individuals Covered | 3788 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 6 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 8579 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $427,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0866224 |
| Policy instance | 7 |
| Insurance contract or identification number | 0866224 | | Number of Individuals Covered | 2589 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LA814C*000 |
| Policy instance | 8 |
| Insurance contract or identification number | LA814C*000 | | Number of Individuals Covered | 2721 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Other welfare benefits provided | ACUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $53,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 436 |
| Policy instance | 9 |
| Insurance contract or identification number | 436 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $246,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker name | MILLIMAN CONSULTANTS & ACTUARIES |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231206 |
| Policy instance | 1 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 8821 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,834,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 2 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 199 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,344,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | * FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | * FOOTNOTE | | Number of Individuals Covered | 1071 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100433-100444 |
| Policy instance | 5 |
| Insurance contract or identification number | 100433-100444 | | Number of Individuals Covered | 4098 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 6 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 7711 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $359,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | FOOTNOTE |
| Policy instance | 4 |
| Insurance contract or identification number | FOOTNOTE | | Number of Individuals Covered | 2984 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCE RATED CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 344,366 |
| Policy instance | 9 |
| Insurance contract or identification number | 344,366 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH814C*000 |
| Policy instance | 8 |
| Insurance contract or identification number | LH814C*000 | | Number of Individuals Covered | 2435 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | ACUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $146,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TSIT |
| Policy instance | 7 |
| Insurance contract or identification number | TSIT | | Number of Individuals Covered | 2491 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100433-100444 |
| Policy instance | 1 |
| Insurance contract or identification number | 100433-100444 | | Number of Individuals Covered | 4090 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPERIENCED RATED CONTRACT | | 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 | 231206 |
| Policy instance | 2 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 8662 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,376,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 344,366 |
| Policy instance | 4 |
| Insurance contract or identification number | 344,366 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,638 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 5 |
| Insurance contract or identification number | SEE FOOTNOTE | | Number of Individuals Covered | 253 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,232,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH814C*000 |
| Policy instance | 6 |
| Insurance contract or identification number | LH814C*000 | | Number of Individuals Covered | 8653 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | ACCUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $148,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | * FOOTNOTE |
| Policy instance | 3 |
| Insurance contract or identification number | * FOOTNOTE | | Number of Individuals Covered | 3801 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $710,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TSIT |
| Policy instance | 8 |
| Insurance contract or identification number | TSIT | | Number of Individuals Covered | 2388 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 7 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 990 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $347,060 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TSIT |
| Policy instance | 7 |
| Insurance contract or identification number | TSIT | | Number of Individuals Covered | 266 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH814C*000 |
| Policy instance | 1 |
| Insurance contract or identification number | LH814C*000 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | ACCUPUNCTURE/CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $8,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | PCF 008 |
| Policy instance | 5 |
| Insurance contract or identification number | PCF 008 | | Number of Individuals Covered | 990 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $1,029 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,859 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1029 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | HM LIFE INSURANCE COMPANY |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | TSIT |
| Policy instance | 4 |
| Insurance contract or identification number | TSIT | | Number of Individuals Covered | 141 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,665 | | 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 | 231206 |
| Policy instance | 3 |
| Insurance contract or identification number | 231206 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,203,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | TSIT |
| Policy instance | 2 |
| Insurance contract or identification number | TSIT | | Number of Individuals Covered | 28 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $184,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100433-100444 |
| Policy instance | 6 |
| Insurance contract or identification number | 100433-100444 | | Number of Individuals Covered | 859 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
