CALIFORNIA CHARTER SCHOOLS EWBT has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CALIFORNIA CHARTER SCHOOLS ASSN. EMPLOYEE WELFARE CARE OF BRMS
401k plan membership statisitcs for CALIFORNIA CHARTER SCHOOLS ASSN. EMPLOYEE WELFARE CARE OF BRMS
| Measure | Date | Value |
|---|
| 2022 : CALIFORNIA CHARTER SCHOOLS ASSN. EMPLOYEE WELFARE CARE OF BRMS 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $90,343 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $194,673 |
| Total income from all sources (including contributions) | 2022-12-31 | $20,986,343 |
| Total of all expenses incurred | 2022-12-31 | $20,652,251 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $19,154,380 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $20,982,491 |
| Value of total assets at end of year | 2022-12-31 | $4,981,733 |
| Value of total assets at beginning of year | 2022-12-31 | $4,751,971 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $1,497,871 |
| Total interest from all sources | 2022-12-31 | $3,852 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $865,756 |
| Was this plan covered by a fidelity bond | 2022-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-12-31 | $5,267 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $1,464 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $127,124 |
| Administrative expenses (other) incurred | 2022-12-31 | $632,115 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $90,343 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $67,549 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $334,092 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $4,891,390 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $4,557,298 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $4,974,892 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $4,748,991 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $4,748,991 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $3,852 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $19,154,380 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $20,977,224 |
| Employer contributions (assets) at end of year | 2022-12-31 | $5,377 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $2,980 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | SINGERLEWAK LLP |
| Accountancy firm EIN | 2022-12-31 | 952302617 |
| 2021 : CALIFORNIA CHARTER SCHOOLS ASSN. EMPLOYEE WELFARE CARE OF BRMS 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $194,673 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $651,419 |
| Total income from all sources (including contributions) | 2021-12-31 | $17,572,468 |
| Total of all expenses incurred | 2021-12-31 | $18,008,652 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $16,675,079 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $17,570,957 |
| Value of total assets at end of year | 2021-12-31 | $4,751,971 |
| Value of total assets at beginning of year | 2021-12-31 | $5,644,901 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $1,333,573 |
| Total interest from all sources | 2021-12-31 | $1,511 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $746,366 |
| Was this plan covered by a fidelity bond | 2021-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $55,098 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $7,095 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $127,124 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $587,650 |
| Administrative expenses (other) incurred | 2021-12-31 | $587,207 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $67,549 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $63,769 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-436,184 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $4,557,298 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $4,993,482 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $4,748,991 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $5,627,120 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $5,627,120 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $1,511 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $16,675,079 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $17,515,859 |
| Employer contributions (assets) at end of year | 2021-12-31 | $2,980 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $10,686 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | SINGERLEWAK LLP |
| Accountancy firm EIN | 2021-12-31 | 952302617 |
| 2020 : CALIFORNIA CHARTER SCHOOLS ASSN. EMPLOYEE WELFARE CARE OF BRMS 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $651,419 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $716,085 |
| Total income from all sources (including contributions) | 2020-12-31 | $23,853,734 |
| Total of all expenses incurred | 2020-12-31 | $23,413,312 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $21,975,420 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $23,849,530 |
| Value of total assets at end of year | 2020-12-31 | $5,644,901 |
| Value of total assets at beginning of year | 2020-12-31 | $5,269,145 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $1,437,892 |
| Total interest from all sources | 2020-12-31 | $4,204 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $720,309 |
| Was this plan covered by a fidelity bond | 2020-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $65,471 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $7,095 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $7,465 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $587,650 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $580,183 |
| Administrative expenses (other) incurred | 2020-12-31 | $717,583 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $63,769 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $135,902 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $440,422 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $4,993,482 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $4,553,060 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $5,627,120 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $5,031,201 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $5,031,201 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $4,204 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $21,975,420 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $23,784,059 |
| Employer contributions (assets) at end of year | 2020-12-31 | $10,686 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $230,479 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | SINGERLEWAK LLP |
| Accountancy firm EIN | 2020-12-31 | 952302617 |
| 2019 : CALIFORNIA CHARTER SCHOOLS ASSN. EMPLOYEE WELFARE CARE OF BRMS 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $716,085 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $716,085 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $222,975 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $222,975 |
| Total income from all sources (including contributions) | 2019-12-31 | $22,342,526 |
| Total income from all sources (including contributions) | 2019-12-31 | $22,342,526 |
| Total of all expenses incurred | 2019-12-31 | $22,321,706 |
| Total of all expenses incurred | 2019-12-31 | $22,321,706 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $20,835,244 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $20,835,244 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $22,330,695 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $22,330,695 |
| Value of total assets at end of year | 2019-12-31 | $5,269,145 |
| Value of total assets at end of year | 2019-12-31 | $5,269,145 |
| Value of total assets at beginning of year | 2019-12-31 | $4,755,215 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,486,462 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,486,462 |
| Total interest from all sources | 2019-12-31 | $11,831 |
| Total interest from all sources | 2019-12-31 | $11,831 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $811,255 |
| Administrative expenses professional fees incurred | 2019-12-31 | $811,255 |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $7,465 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $7,465 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $7,716 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $580,183 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $580,183 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $222,475 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $222,475 |
| Administrative expenses (other) incurred | 2019-12-31 | $675,207 |
| Administrative expenses (other) incurred | 2019-12-31 | $675,207 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $135,902 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $135,902 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $20,820 |
| Value of net income/loss | 2019-12-31 | $20,820 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $4,553,060 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $4,553,060 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $4,532,240 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $4,532,240 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $5,031,201 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $5,031,201 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $4,615,610 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $4,615,610 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $11,831 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $11,831 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $20,835,244 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $20,835,244 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $22,330,695 |
| Contributions received in cash from employer | 2019-12-31 | $22,330,695 |
| Employer contributions (assets) at end of year | 2019-12-31 | $230,479 |
| Employer contributions (assets) at end of year | 2019-12-31 | $230,479 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $131,889 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | SINGERLEWAK LLP |
| Accountancy firm name | 2019-12-31 | SINGERLEWAK LLP |
| Accountancy firm EIN | 2019-12-31 | 952302617 |
| Accountancy firm EIN | 2019-12-31 | 952302617 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230290 |
| Policy instance | 11 |
| Insurance contract or identification number | 230290 | | Number of Individuals Covered | 1312 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 $6,576,733 | | 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 | 603027 |
| Policy instance | 1 |
| Insurance contract or identification number | 603027 | | Number of Individuals Covered | 576 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 $3,171,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | G0360 |
| Policy instance | 2 |
| Insurance contract or identification number | G0360 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | 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 $1,129,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | G0200 |
| Policy instance | 3 |
| Insurance contract or identification number | G0200 | | Number of Individuals Covered | 601 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | 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 $1,917,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 604158 |
| Policy instance | 4 |
| Insurance contract or identification number | 604158 | | Number of Individuals Covered | 1739 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $632 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 632 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30049559 |
| Policy instance | 5 |
| Insurance contract or identification number | 30049559 | | Number of Individuals Covered | 1217 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | 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 $235,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 17072 |
| Policy instance | 6 |
| Insurance contract or identification number | 17072 | | Number of Individuals Covered | 2587 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76970 |
| Policy instance | 7 |
| Insurance contract or identification number | 76970 | | Number of Individuals Covered | 620 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4664595 |
| Policy instance | 8 |
| Insurance contract or identification number | E4664595 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $2,258 | | Total amount of fees paid to insurance company | USD $1 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,537 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | N/A |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 631100 |
| Policy instance | 9 |
| Insurance contract or identification number | 631100 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-07-01 | | Total amount of commissions paid to insurance broker | USD $10,023 | | Total amount of fees paid to insurance company | USD $1,146 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,230 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,023 | | Amount paid for insurance broker fees | 1146 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 435967 |
| Policy instance | 10 |
| Insurance contract or identification number | 435967 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-07-01 | | Total amount of commissions paid to insurance broker | USD $1,843 | | Total amount of fees paid to insurance company | USD $149 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,843 | | Amount paid for insurance broker fees | 149 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 604158 |
| Policy instance | 4 |
| Insurance contract or identification number | 604158 | | Number of Individuals Covered | 1507 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $403 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 403 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30049559 |
| Policy instance | 5 |
| Insurance contract or identification number | 30049559 | | Number of Individuals Covered | 1278 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | 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 $196,143 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 17072 |
| Policy instance | 6 |
| Insurance contract or identification number | 17072 | | Number of Individuals Covered | 2384 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $426,258 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76970 |
| Policy instance | 7 |
| Insurance contract or identification number | 76970 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4664595 |
| Policy instance | 8 |
| Insurance contract or identification number | E4664595 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $1,077 | | Total amount of fees paid to insurance company | USD $46 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $610 | | Amount paid for insurance broker fees | 45 | | Additional information about fees paid to insurance broker | N/A |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 631100 |
| Policy instance | 9 |
| Insurance contract or identification number | 631100 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-07-01 | | Total amount of commissions paid to insurance broker | USD $9,207 | | Total amount of fees paid to insurance company | USD $887 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,207 | | Amount paid for insurance broker fees | 887 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 435967 |
| Policy instance | 10 |
| Insurance contract or identification number | 435967 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-07-01 | | Total amount of commissions paid to insurance broker | USD $1,013 | | Total amount of fees paid to insurance company | USD $129 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,013 | | Amount paid for insurance broker fees | 129 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | G0200 |
| Policy instance | 3 |
| Insurance contract or identification number | G0200 | | Number of Individuals Covered | 604 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,795,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | G0360 |
| Policy instance | 2 |
| Insurance contract or identification number | G0360 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,399,644 | | 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 | 603027 |
| Policy instance | 1 |
| Insurance contract or identification number | 603027 | | Number of Individuals Covered | 534 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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 $3,258,093 | | 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 | 603027 |
| Policy instance | 1 |
| Insurance contract or identification number | 603027 | | Number of Individuals Covered | 505 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | 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 $3,336,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | G0360 |
| Policy instance | 2 |
| Insurance contract or identification number | G0360 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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 $3,960,055 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | G0200 |
| Policy instance | 3 |
| Insurance contract or identification number | G0200 | | Number of Individuals Covered | 583 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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 $4,009,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 604158 |
| Policy instance | 4 |
| Insurance contract or identification number | 604158 | | Number of Individuals Covered | 1809 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 463 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30049559 |
| Policy instance | 5 |
| Insurance contract or identification number | 30049559 | | Number of Individuals Covered | 1219 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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 $244,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 17072 |
| Policy instance | 6 |
| Insurance contract or identification number | 17072 | | Number of Individuals Covered | 1943 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,071,321 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76970 |
| Policy instance | 7 |
| Insurance contract or identification number | 76970 | | Number of Individuals Covered | 431 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,051 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4664595 |
| Policy instance | 8 |
| Insurance contract or identification number | E4664595 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $426 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | N/A |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 631100 |
| Policy instance | 9 |
| Insurance contract or identification number | 631100 | | Number of Individuals Covered | 319 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,436 | | Amount paid for insurance broker fees | 783 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | G0360 |
| Policy instance | 2 |
| Insurance contract or identification number | G0360 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | 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 $3,791,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | G0200 |
| Policy instance | 3 |
| Insurance contract or identification number | G0200 | | Number of Individuals Covered | 753 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | 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 $4,314,447 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 604158 |
| Policy instance | 4 |
| Insurance contract or identification number | 604158 | | Number of Individuals Covered | 1969 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,488 | | 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: 00000 ) |
| Policy contract number | 30049559 |
| Policy instance | 5 |
| Insurance contract or identification number | 30049559 | | Number of Individuals Covered | 1664 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | 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 $281,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 17072 |
| Policy instance | 6 |
| Insurance contract or identification number | 17072 | | Number of Individuals Covered | 2567 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,287,803 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76970 |
| Policy instance | 7 |
| Insurance contract or identification number | 76970 | | Number of Individuals Covered | 1591 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $228,619 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4664595 |
| Policy instance | 8 |
| Insurance contract or identification number | E4664595 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 631100 |
| Policy instance | 9 |
| Insurance contract or identification number | 631100 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,708 | | 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 | 603027 |
| Policy instance | 1 |
| Insurance contract or identification number | 603027 | | Number of Individuals Covered | 419 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | 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 $2,915,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
