401k Plan data: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY plan

GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 401k Plan overview

Plan Name	GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY
Plan identification number	501

GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

GENUINE PARTS COMPANY has sponsored the creation of one or more 401k plans.

Company Name: GENUINE PARTS COMPANY

Employer identification number (EIN): 580254510

NAIC Classification: 423100

Additional information about GENUINE PARTS COMPANY

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1938-06-01

Company Identification Number: 136065

More information about GENUINE PARTS COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 CHARLIE CHESNUTT
501 2017-01-01 CHARLIE CHESNUTT
501 2016-01-01 CHARLIE CHESNUTT
501 2015-01-01 CHARLIE CHESNUTT
501 2014-01-01 FRANK M. HOWARD
501 2013-01-01 FRANK M. HOWARD FRANK M. HOWARD 2014-07-24
501 2012-01-01 FRANK M. HOWARD FRANK M. HOWARD 2013-07-25
501 2011-01-01 FRANK M. HOWARD FRANK M. HOWARD 2012-07-24
501 2010-01-01 FRANK M. HOWARD FRANK M. HOWARD 2011-07-22
501 2009-01-01 FRANK HOWARD FRANK M. HOWARD 2010-07-30

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01	CHARLIE CHESNUTT
501	2017-01-01	CHARLIE CHESNUTT
501	2016-01-01	CHARLIE CHESNUTT
501	2015-01-01	CHARLIE CHESNUTT
501	2014-01-01	FRANK M. HOWARD
501	2013-01-01	FRANK M. HOWARD	FRANK M. HOWARD	2014-07-24
501	2012-01-01	FRANK M. HOWARD	FRANK M. HOWARD	2013-07-25
501	2011-01-01	FRANK M. HOWARD	FRANK M. HOWARD	2012-07-24
501	2010-01-01	FRANK M. HOWARD	FRANK M. HOWARD	2011-07-22
501	2009-01-01	FRANK HOWARD	FRANK M. HOWARD	2010-07-30

Plan Statistics for GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

401k plan membership statisitcs for GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

Measure Date Value
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2022 401k membership
Total participants, beginning-of-year 2022-01-01 19,922
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 21,780
Number of retired or separated participants receiving benefits 2022-01-01 187
Total of all active and inactive participants 2022-01-01 21,967
Total participants 2022-01-01 21,967
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2021 401k membership
Total participants, beginning-of-year 2021-01-01 22,408
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 19,750
Number of retired or separated participants receiving benefits 2021-01-01 172
Total of all active and inactive participants 2021-01-01 19,922
Total participants 2021-01-01 19,922
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2020 401k membership
Total participants, beginning-of-year 2020-01-01 24,366
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 21,716
Number of retired or separated participants receiving benefits 2020-01-01 692
Total of all active and inactive participants 2020-01-01 22,408
Total participants 2020-01-01 22,408
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2019 401k membership
Total participants, beginning-of-year 2019-01-01 24,143
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 23,461
Number of retired or separated participants receiving benefits 2019-01-01 905
Total of all active and inactive participants 2019-01-01 24,366
Total participants 2019-01-01 24,366
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2018 401k membership
Total participants, beginning-of-year 2018-01-01 23,646
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 23,311
Number of retired or separated participants receiving benefits 2018-01-01 832
Total of all active and inactive participants 2018-01-01 24,143
Total participants 2018-01-01 24,143
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 22,828
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 22,679
Number of retired or separated participants receiving benefits 2017-01-01 967
Total of all active and inactive participants 2017-01-01 23,646
Total participants 2017-01-01 23,646
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 22,093
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 21,798
Number of retired or separated participants receiving benefits 2016-01-01 1,030
Total of all active and inactive participants 2016-01-01 22,828
Total participants 2016-01-01 22,828
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 21,798
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 21,059
Number of retired or separated participants receiving benefits 2015-01-01 1,034
Total of all active and inactive participants 2015-01-01 22,093
Total participants 2015-01-01 22,093
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 21,486
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 20,623
Number of retired or separated participants receiving benefits 2014-01-01 1,175
Total of all active and inactive participants 2014-01-01 21,798
Total participants 2014-01-01 21,798
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 21,604
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 20,134
Number of retired or separated participants receiving benefits 2013-01-01 1,352
Total of all active and inactive participants 2013-01-01 21,486
Total participants 2013-01-01 21,486
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2012 401k membership
Total participants, beginning-of-year 2012-01-01 21,776
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 20,223
Number of retired or separated participants receiving benefits 2012-01-01 1,381
Total of all active and inactive participants 2012-01-01 21,604
Total participants 2012-01-01 21,604
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2011 401k membership
Total participants, beginning-of-year 2011-01-01 22,349
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 20,271
Number of retired or separated participants receiving benefits 2011-01-01 1,505
Total of all active and inactive participants 2011-01-01 21,776
Total participants 2011-01-01 21,776
2010: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2010 401k membership
Total participants, beginning-of-year 2010-01-01 24,048
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 20,442
Number of retired or separated participants receiving benefits 2010-01-01 1,907
Total of all active and inactive participants 2010-01-01 22,349
Total participants 2010-01-01 22,349
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2009 401k membership
Total participants, beginning-of-year 2009-01-01 25,151
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 21,177
Number of retired or separated participants receiving benefits 2009-01-01 2,871
Total of all active and inactive participants 2009-01-01 24,048
Total participants 2009-01-01 24,048

Measure	Date	Value
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2022 401k membership
Total participants, beginning-of-year	2022-01-01	19,922
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	21,780
Number of retired or separated participants receiving benefits	2022-01-01	187
Total of all active and inactive participants	2022-01-01	21,967
Total participants	2022-01-01	21,967
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2021 401k membership
Total participants, beginning-of-year	2021-01-01	22,408
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	19,750
Number of retired or separated participants receiving benefits	2021-01-01	172
Total of all active and inactive participants	2021-01-01	19,922
Total participants	2021-01-01	19,922
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2020 401k membership
Total participants, beginning-of-year	2020-01-01	24,366
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	21,716
Number of retired or separated participants receiving benefits	2020-01-01	692
Total of all active and inactive participants	2020-01-01	22,408
Total participants	2020-01-01	22,408
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2019 401k membership
Total participants, beginning-of-year	2019-01-01	24,143
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	23,461
Number of retired or separated participants receiving benefits	2019-01-01	905
Total of all active and inactive participants	2019-01-01	24,366
Total participants	2019-01-01	24,366
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2018 401k membership
Total participants, beginning-of-year	2018-01-01	23,646
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	23,311
Number of retired or separated participants receiving benefits	2018-01-01	832
Total of all active and inactive participants	2018-01-01	24,143
Total participants	2018-01-01	24,143
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	22,828
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	22,679
Number of retired or separated participants receiving benefits	2017-01-01	967
Total of all active and inactive participants	2017-01-01	23,646
Total participants	2017-01-01	23,646
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	22,093
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	21,798
Number of retired or separated participants receiving benefits	2016-01-01	1,030
Total of all active and inactive participants	2016-01-01	22,828
Total participants	2016-01-01	22,828
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	21,798
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	21,059
Number of retired or separated participants receiving benefits	2015-01-01	1,034
Total of all active and inactive participants	2015-01-01	22,093
Total participants	2015-01-01	22,093
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	21,486
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	20,623
Number of retired or separated participants receiving benefits	2014-01-01	1,175
Total of all active and inactive participants	2014-01-01	21,798
Total participants	2014-01-01	21,798
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	21,604
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	20,134
Number of retired or separated participants receiving benefits	2013-01-01	1,352
Total of all active and inactive participants	2013-01-01	21,486
Total participants	2013-01-01	21,486
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2012 401k membership
Total participants, beginning-of-year	2012-01-01	21,776
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	20,223
Number of retired or separated participants receiving benefits	2012-01-01	1,381
Total of all active and inactive participants	2012-01-01	21,604
Total participants	2012-01-01	21,604
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2011 401k membership
Total participants, beginning-of-year	2011-01-01	22,349
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	20,271
Number of retired or separated participants receiving benefits	2011-01-01	1,505
Total of all active and inactive participants	2011-01-01	21,776
Total participants	2011-01-01	21,776
2010: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2010 401k membership
Total participants, beginning-of-year	2010-01-01	24,048
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	20,442
Number of retired or separated participants receiving benefits	2010-01-01	1,907
Total of all active and inactive participants	2010-01-01	22,349
Total participants	2010-01-01	22,349
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2009 401k membership
Total participants, beginning-of-year	2009-01-01	25,151
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	21,177
Number of retired or separated participants receiving benefits	2009-01-01	2,871
Total of all active and inactive participants	2009-01-01	24,048
Total participants	2009-01-01	24,048

Form 5500 Responses for GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

75587

Policy instance

Insurance contract or identification number	75587
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	STATUTORY DISABILITY NY
Welfare Benefit Premiums Paid to Carrier	USD $351,793
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

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	50
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 $341,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	90
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 $1,345,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	27749
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 $1,532,383
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

681391G,S08931

Policy instance

Insurance contract or identification number	681391G,S08931
Number of Individuals Covered	25825
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $102,269
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,108,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	102269
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

980335,980153

Policy instance

Insurance contract or identification number	980335,980153
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $3,839,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B 03122D

Policy instance

Insurance contract or identification number	03122B 03122D
Number of Individuals Covered	3
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $284
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $24,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $284
Additional information about fees paid to insurance broker	SALES AND SERVICE OVERRIDE
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	54
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 $357,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	93
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 $1,230,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	25440
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 $1,666,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	3
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $5,748
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $57,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5748
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681391G,S08931

Policy instance

Insurance contract or identification number	681391G,S08931
Number of Individuals Covered	26965
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $102,845
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,777,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	102845
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

980335,980153

Policy instance

Insurance contract or identification number	980335,980153
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $30,160
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $632,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	30160
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075587

Policy instance

Insurance contract or identification number	NYD075587
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $1,338
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $72,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1338
Additional information about fees paid to insurance broker	SALES AND SERVICE OVERRIDE
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	54
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 $374,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	106
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 $1,235,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	26726
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 $1,501,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	5
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $16,415
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $164,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16415
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681391G,S08931

Policy instance

Insurance contract or identification number	681391G,S08931
Number of Individuals Covered	22589
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $72,927
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,394,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	72927
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

980335,980153

Policy instance

Insurance contract or identification number	980335,980153
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $31,863
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $3,907,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	31863
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075587

Policy instance

Insurance contract or identification number	NYD075587
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $1,016
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $151,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1016
Additional information about fees paid to insurance broker	SALES AND SERVICE OVERRIDE
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	49
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 $315,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	114
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 $1,338,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	4
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,000
Total amount of fees paid to insurance company	USD $11,003
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $186,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11003
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $10,000

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	31924
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 $1,593,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	5
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,759
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $137,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,759
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681391G,S08931

Policy instance

Insurance contract or identification number	681391G,S08931
Number of Individuals Covered	26724
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $67,302
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,158,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	67302
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

980335,980153

Policy instance

Insurance contract or identification number	980335,980153
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $70,958
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $3,906,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	70958
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075587

Policy instance

Insurance contract or identification number	NYD075587
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $681
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $102,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	681
Additional information about fees paid to insurance broker	OVERRIDE

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	37
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $203,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	25008
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $81,951
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,146,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,951
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	133
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,312,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	20138
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $80,000
Total amount of fees paid to insurance company	USD $59,110
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,635,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	59018
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $80,000

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	31729
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,714,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	5
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,039
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $104,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,039
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	11
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $73,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	31154
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 $1,803,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	20898
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $40,000
Total amount of fees paid to insurance company	USD $68,290
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,277,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,000
Amount paid for insurance broker fees	68290
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE INC

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	137
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 $1,190,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	24919
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $167,215
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,866,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $167,215
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PA INC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	49
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 $291,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	53
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 $287,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	23489
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $73,788
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,586,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,788
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PA INC

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	140
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 $864,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	21059
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $50,000
Total amount of fees paid to insurance company	USD $56,356
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,640,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,000
Amount paid for insurance broker fees	56325
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PENNSYLVANIA INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	21059
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 $1,467,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	3
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $57,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	136
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 $806,548
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

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	51
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 $229,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	20623
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $115,000
Total amount of fees paid to insurance company	USD $90,939
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,352,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $115,000
Amount paid for insurance broker fees	90939
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PENNSYLVANIA INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	20623
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 $1,448,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $53,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	22884
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $70,091
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,561,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,091
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PA INC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	22423
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $446
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,684,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $446
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PA INC

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	3
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $82,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	20134
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,677,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	20048
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,458,537
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

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	53
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $275,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	136
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $834,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	4
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $72,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	20223
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,388,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	18903
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,896,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	142
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $949,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	21438
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $47,060
Total amount of fees paid to insurance company	USD $46,577
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,719,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,060
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	46577
Insurance broker name	DG3 NORTH AMERICA INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	60
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $324,775
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

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	82
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $282,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	16399
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $22,537
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,657,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	140
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $978,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	18585
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,463,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	20271
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,477,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

03122B

Policy instance

Insurance contract or identification number	03122B
Number of Individuals Covered	3
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $60,164
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

1166/10

Policy instance

Insurance contract or identification number	1166/10
Number of Individuals Covered	68
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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 $220,661

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

749521,2,3,4,56

Policy instance

Insurance contract or identification number	749521,2,3,4,56
Number of Individuals Covered	22349
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $87,353
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,438,222
Commission paid to Insurance Broker	USD $87,353
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PA INC

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

4828, 96613

Policy instance

Insurance contract or identification number	4828, 96613
Number of Individuals Covered	148
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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 $1,123,024

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

261,566,720,772

Policy instance

Insurance contract or identification number	261,566,720,772
Number of Individuals Covered	19535
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,286,435

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9660952

Policy instance

Insurance contract or identification number	9660952
Number of Individuals Covered	22349
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,441,070

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

03122A

Policy instance

Insurance contract or identification number	03122A
Number of Individuals Covered	5
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $122,923

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Company Name:	GENUINE PARTS COMPANY
Employer identification number (EIN):	580254510
NAIC Classification:	423100

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1938-06-01
Company Identification Number:	136065