UNITED FOOD AND COMMERCIAL WORKERS INTERNATIONAL UNION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UFCW HEALTH INSURANCE PLAN FOR RETIREES
| Measure | Date | Value |
|---|
| 2015: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 3,109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 3,082 |
| Total of all active and inactive participants | 2015-03-01 | 3,082 |
| 2014: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 3,115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 3,109 |
| Total of all active and inactive participants | 2014-03-01 | 3,109 |
| 2013: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 3,095 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 3,115 |
| Total of all active and inactive participants | 2013-03-01 | 3,115 |
| 2012: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 3,086 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 3,095 |
| Total of all active and inactive participants | 2012-03-01 | 3,095 |
| 2011: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 3,258 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 3,086 |
| Total of all active and inactive participants | 2011-03-01 | 3,086 |
| 2010: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-03-01 | 3,104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-03-01 | 3,258 |
| Total of all active and inactive participants | 2010-03-01 | 3,258 |
| 2009: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-03-01 | 3,090 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 3,104 |
| Total of all active and inactive participants | 2009-03-01 | 3,104 |
| Measure | Date | Value |
|---|
| 2016 : UFCW HEALTH INSURANCE PLAN FOR RETIREES 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-02-29 | $4,242,007 |
| Total of all expenses incurred | 2016-02-29 | $3,902,630 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-02-29 | $3,549,418 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-02-29 | $2,894,397 |
| Value of total assets at end of year | 2016-02-29 | $339,377 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-02-29 | $353,212 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-02-29 | No |
| Was this plan covered by a fidelity bond | 2016-02-29 | Yes |
| Value of fidelity bond cover | 2016-02-29 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-02-29 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-02-29 | No |
| Contributions received from participants | 2016-02-29 | $171,481 |
| Other income not declared elsewhere | 2016-02-29 | $1,347,610 |
| Administrative expenses (other) incurred | 2016-02-29 | $353,212 |
| Total non interest bearing cash at end of year | 2016-02-29 | $339,377 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-02-29 | No |
| Value of net income/loss | 2016-02-29 | $339,377 |
| Value of net assets at end of year (total assets less liabilities) | 2016-02-29 | $339,377 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-02-29 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-02-29 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-02-29 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-02-29 | $3,549,418 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-02-29 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-02-29 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-02-29 | No |
| Contributions received in cash from employer | 2016-02-29 | $2,722,916 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-02-29 | No |
| Did the plan have assets held for investment | 2016-02-29 | 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 | 2016-02-29 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-02-29 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-02-29 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-02-29 | Unqualified |
| Accountancy firm name | 2016-02-29 | CALIBRE CPA GROUP PLLC |
| Accountancy firm EIN | 2016-02-29 | 470900880 |
| 2015: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Submission has been amended | Yes |
| 2015-03-01 | Plan funding arrangement – Insurance | Yes |
| 2015-03-01 | Plan funding arrangement – Trust | Yes |
| 2015-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement - Trust | Yes |
| 2015-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | Plan funding arrangement – Insurance | Yes |
| 2014-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2013 form 5500 responses |
|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Plan funding arrangement – Insurance | Yes |
| 2013-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2012 form 5500 responses |
|---|
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | Plan funding arrangement – Insurance | Yes |
| 2012-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2011 form 5500 responses |
|---|
| 2011-03-01 | Type of plan entity | Single employer plan |
| 2011-03-01 | Plan funding arrangement – Insurance | Yes |
| 2011-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2010 form 5500 responses |
|---|
| 2010-03-01 | Type of plan entity | Single employer plan |
| 2010-03-01 | Plan funding arrangement – Insurance | Yes |
| 2010-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: UFCW HEALTH INSURANCE PLAN FOR RETIREES 2009 form 5500 responses |
|---|
| 2009-03-01 | Type of plan entity | Single employer plan |
| 2009-03-01 | This submission is the final filing | No |
| 2009-03-01 | Plan funding arrangement – Insurance | Yes |
| 2009-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 131246 |
| Policy instance | 2 |
| Insurance contract or identification number | 131246 | | Number of Individuals Covered | 56 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $233,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10042 |
| Policy instance | 3 |
| Insurance contract or identification number | SL10042 | | Number of Individuals Covered | 819 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $215,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G/C-8177 |
| Policy instance | 1 |
| Insurance contract or identification number | G/C-8177 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $19,894 | | 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 | 131246 |
| Policy instance | 2 |
| Insurance contract or identification number | 131246 | | Number of Individuals Covered | 57 | | 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 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $208,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G/C-8177 |
| Policy instance | 1 |
| Insurance contract or identification number | G/C-8177 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $25,653 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10042 |
| Policy instance | 3 |
| Insurance contract or identification number | SL10042 | | Number of Individuals Covered | 847 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $223,817 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10042 |
| Policy instance | 3 |
| Insurance contract or identification number | SL10042 | | Number of Individuals Covered | 4158 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $699,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G/C-8177 |
| Policy instance | 1 |
| Insurance contract or identification number | G/C-8177 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $30,217 | | 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 | 131246 |
| Policy instance | 2 |
| Insurance contract or identification number | 131246 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $190,423 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G/C-8177 |
| Policy instance | 1 |
| Insurance contract or identification number | G/C-8177 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $32,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10042 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10042 | | Number of Individuals Covered | 4233 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $723,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 4501 |
| Policy instance | 2 |
| Insurance contract or identification number | 4501 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 | 131246 |
| Policy instance | 3 |
| Insurance contract or identification number | 131246 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $275,523 | | 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 | 131246 |
| Policy instance | 4 |
| Insurance contract or identification number | 131246 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $245,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 4501-14 |
| Policy instance | 3 |
| Insurance contract or identification number | 4501-14 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | GA-8177 |
| Policy instance | 2 |
| Insurance contract or identification number | GA-8177 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | POOLED AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G/C-8177 |
| Policy instance | 1 |
| Insurance contract or identification number | G/C-8177 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10042 |
| Policy instance | 5 |
| Insurance contract or identification number | SL10042 | | Number of Individuals Covered | 2767 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $736,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10042 |
| Policy instance | 5 |
| Insurance contract or identification number | SL10042 | | Number of Individuals Covered | 4250 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $706,954 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 4501-16 |
| Policy instance | 3 |
| Insurance contract or identification number | 4501-16 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,729 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | GA-8177 |
| Policy instance | 2 |
| Insurance contract or identification number | GA-8177 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | POOLED AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G/C-8177 |
| Policy instance | 1 |
| Insurance contract or identification number | G/C-8177 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,087 | | 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 | 131246 |
| Policy instance | 4 |
| Insurance contract or identification number | 131246 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $242,767 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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