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COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 401k Plan overview

Plan NameCOMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN
Plan identification number 504

COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN Benefits

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

401k Sponsoring company profile

COMMUNICATIONS WORKERS OF AMERICA, AFL-CIO, CLC has sponsored the creation of one or more 401k plans.

Company Name:COMMUNICATIONS WORKERS OF AMERICA, AFL-CIO, CLC
Employer identification number (EIN):530246709
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-01-01AMEENAH SALAAM2023-10-11
5042021-01-01SARA STEFFENS2022-10-17
5042020-01-01SARA STEFFENS2021-09-07
5042019-01-01SARA STEFFENS2020-10-14
5042018-01-01SARA STEFFENS2019-07-23
5042017-01-01
5042016-01-01
5042015-01-01
5042014-01-01
5042013-01-01
5042012-01-01THERESA PLUTA
5042011-01-01THERESA PLUTA
5042010-01-01THERESA PLUTA
5042009-01-01THERESA PLUTA

Plan Statistics for COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN

401k plan membership statisitcs for COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN

Measure Date Value
2022: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01512
Total number of active participants reported on line 7a of the Form 55002022-01-01430
Number of retired or separated participants receiving benefits2022-01-0186
Total of all active and inactive participants2022-01-01516
2021: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01542
Total number of active participants reported on line 7a of the Form 55002021-01-01122
Number of retired or separated participants receiving benefits2021-01-0193
Total of all active and inactive participants2021-01-01215
2020: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01543
Total number of active participants reported on line 7a of the Form 55002020-01-01430
Number of retired or separated participants receiving benefits2020-01-01112
Total of all active and inactive participants2020-01-01542
2019: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01552
Total number of active participants reported on line 7a of the Form 55002019-01-01423
Number of retired or separated participants receiving benefits2019-01-01120
Total of all active and inactive participants2019-01-01543
2018: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01588
Total number of active participants reported on line 7a of the Form 55002018-01-01429
Number of retired or separated participants receiving benefits2018-01-01123
Total of all active and inactive participants2018-01-01552
2017: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01602
Total number of active participants reported on line 7a of the Form 55002017-01-01470
Number of retired or separated participants receiving benefits2017-01-01118
Total of all active and inactive participants2017-01-01588
2016: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01612
Total number of active participants reported on line 7a of the Form 55002016-01-01481
Number of retired or separated participants receiving benefits2016-01-01121
Total of all active and inactive participants2016-01-01602
2015: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,207
Total number of active participants reported on line 7a of the Form 55002015-01-01469
Number of retired or separated participants receiving benefits2015-01-01143
Total of all active and inactive participants2015-01-01612
2014: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,197
Total number of active participants reported on line 7a of the Form 55002014-01-01444
Number of retired or separated participants receiving benefits2014-01-01763
Total of all active and inactive participants2014-01-011,207
2013: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,224
Total number of active participants reported on line 7a of the Form 55002013-01-01441
Number of retired or separated participants receiving benefits2013-01-01756
Total of all active and inactive participants2013-01-011,197
2012: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,129
Total number of active participants reported on line 7a of the Form 55002012-01-01457
Number of retired or separated participants receiving benefits2012-01-01767
Total of all active and inactive participants2012-01-011,224
2011: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,242
Total number of active participants reported on line 7a of the Form 55002011-01-01456
Number of retired or separated participants receiving benefits2011-01-01673
Total of all active and inactive participants2011-01-011,129
2010: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,364
Total number of active participants reported on line 7a of the Form 55002010-01-01471
Number of retired or separated participants receiving benefits2010-01-01771
Total of all active and inactive participants2010-01-011,242
2009: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,678
Total number of active participants reported on line 7a of the Form 55002009-01-01523
Number of retired or separated participants receiving benefits2009-01-01642
Total of all active and inactive participants2009-01-011,165

Form 5500 Responses for COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN

2022: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: COMMUNICATIONS WORKERS OF AMERICA GROUP HOSPITALIZATION PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered495
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $354,144
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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered34
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $261,509
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered509
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $305,447
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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered32
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $248,074
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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered30
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $240,438
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered541
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $220,065
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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered12
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $144,812
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered544
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $211,398
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 number21076
Policy instance 1
Insurance contract or identification number21076
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Insurance policy start date2016-07-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered15
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $130,947
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered621
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $243,413
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered628
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $276,157
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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered16
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $137,895
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 numberSL10091
Policy instance 2
Insurance contract or identification numberSL10091
Number of Individuals Covered662
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $250,115
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 number21076
Policy instance 1
Insurance contract or identification number21076
Number of Individuals Covered18
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $144,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number06104840
Policy instance 1
Insurance contract or identification number06104840
Number of Individuals Covered1257
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
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 number21076
Policy instance 4
Insurance contract or identification number21076
Number of Individuals Covered19
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $152,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number12081
Policy instance 2
Insurance contract or identification number12081
Number of Individuals Covered1279
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $996,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract numberR189
Policy instance 3
Insurance contract or identification numberR189
Number of Individuals Covered1475
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $98,940
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98,940
Insurance broker nameTHE SEGAL COMPANY
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberSL10091
Policy instance 5
Insurance contract or identification numberSL10091
Number of Individuals Covered665
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $225,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number66319-1
Policy instance 7
Insurance contract or identification number66319-1
Number of Individuals Covered717
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $329,078
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 number21076
Policy instance 6
Insurance contract or identification number21076
Number of Individuals Covered12
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $170,225
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 number4901-26
Policy instance 4
Insurance contract or identification number4901-26
Number of Individuals Covered3
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $41,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract numberR189
Policy instance 3
Insurance contract or identification numberR189
Number of Individuals Covered1468
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $92,398
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number1204
Policy instance 2
Insurance contract or identification number1204
Number of Individuals Covered1296
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,003,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number06104840
Policy instance 1
Insurance contract or identification number06104840
Number of Individuals Covered1291
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
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 number4901-22
Policy instance 5
Insurance contract or identification number4901-22
Number of Individuals Covered0
Insurance policy start date2010-07-06
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $5,799
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 number21076
Policy instance 7
Insurance contract or identification number21076
Number of Individuals Covered11
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $151,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number06104840
Policy instance 1
Insurance contract or identification number06104840
Number of Individuals Covered1351
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameVISION SERVICE PLAN
DELTA DENTAL OF THE DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1204
Policy instance 2
Insurance contract or identification number1204
Number of Individuals Covered1393
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,064,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract numberR189
Policy instance 3
Insurance contract or identification numberR189
Number of Individuals Covered1524
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $88,584
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $88,584
Insurance broker nameTHE SEGAL COMPANY
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number4901-9
Policy instance 4
Insurance contract or identification number4901-9
Number of Individuals Covered2
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $8,311
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 number4901-26
Policy instance 5
Insurance contract or identification number4901-26
Number of Individuals Covered3
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $41,187
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 number4901-22
Policy instance 6
Insurance contract or identification number4901-22
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $5,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number66319-1
Policy instance 8
Insurance contract or identification number66319-1
Number of Individuals Covered1932
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedINDIVIDUAL EXCESS RISK
Welfare Benefit Premiums Paid to CarrierUSD $349,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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