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PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 401k Plan overview

Plan NamePSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN
Plan identification number 501

PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN Benefits

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

401k Sponsoring company profile

PSEA,PSEBA,PSFCU, AND SJPECU RETIREE MEDICAL BENEFITS TRUST has sponsored the creation of one or more 401k plans.

Company Name:PSEA,PSEBA,PSFCU, AND SJPECU RETIREE MEDICAL BENEFITS TRUST
Employer identification number (EIN):680383491
NAIC Classification:525920
NAIC Description:Trusts, Estates, and Agency Accounts

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01VICKI TURANO
5012015-01-01VICKI TURANO
5012014-01-01VICKI TURANO
5012013-01-01VICKI TURANO
5012012-01-01VICKI TURANO
5012011-01-01VICKI TURANO
5012009-01-01VICKI TURANO
5012008-01-01VICKI TURANO
5012007-01-01VICKI TURANO
5012006-01-01VICKI TURANO
5012005-01-01VICKI TURANO
5012004-01-01VICKI TURANO

Plan Statistics for PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN

401k plan membership statisitcs for PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN

Measure Date Value
2016: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0116
Number of retired or separated participants receiving benefits2016-01-0112
Total of all active and inactive participants2016-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-013
Total participants2016-01-0115
2015: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0116
Number of retired or separated participants receiving benefits2015-01-0113
Total of all active and inactive participants2015-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-013
Total participants2015-01-0116
2014: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0116
Number of retired or separated participants receiving benefits2014-01-0113
Total of all active and inactive participants2014-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-013
Total participants2014-01-0116
2013: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0117
Number of retired or separated participants receiving benefits2013-01-0113
Total of all active and inactive participants2013-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-013
Total participants2013-01-0116
2012: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0117
Number of retired or separated participants receiving benefits2012-01-0114
Total of all active and inactive participants2012-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-013
Total participants2012-01-0117
2011: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0117
Number of retired or separated participants receiving benefits2011-01-0114
Total of all active and inactive participants2011-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-013
Total participants2011-01-0117
2009: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0117
Number of retired or separated participants receiving benefits2009-01-0114
Total of all active and inactive participants2009-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-013
Total participants2009-01-0117
2008: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-0118
Number of retired or separated participants receiving benefits2008-01-0114
Total of all active and inactive participants2008-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-01-013
Total participants2008-01-0117
2007: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-0120
Number of retired or separated participants receiving benefits2007-01-0116
Total of all active and inactive participants2007-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-01-012
Total participants2007-01-0118
2006: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-0123
Number of retired or separated participants receiving benefits2006-01-0118
Total of all active and inactive participants2006-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-01-012
Total participants2006-01-0120
2005: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-0125
Number of retired or separated participants receiving benefits2005-01-0121
Total of all active and inactive participants2005-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2005-01-012
Total participants2005-01-0123
2004: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-0126
Number of retired or separated participants receiving benefits2004-01-0122
Total of all active and inactive participants2004-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2004-01-013
Total participants2004-01-0125

Financial Data on PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN

Measure Date Value
2015 : PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$31,543
Expenses. Total of all expenses incurred2015-12-31$120,131
Benefits paid (including direct rollovers)2015-12-31$114,487
Total plan assets at end of year2015-12-31$286,077
Total plan assets at beginning of year2015-12-31$374,665
Value of fidelity bond covering the plan2015-12-31$1,000,000
Total contributions received or receivable from participants2015-12-31$29,984
Expenses. Other expenses not covered elsewhere2015-12-31$5,644
Other income received2015-12-31$1,559
Net income (gross income less expenses)2015-12-31$-88,588
Net plan assets at end of year (total assets less liabilities)2015-12-31$286,077
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$374,665
2014 : PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$34,273
Expenses. Total of all expenses incurred2014-12-31$110,480
Benefits paid (including direct rollovers)2014-12-31$107,336
Total plan assets at end of year2014-12-31$374,665
Total plan assets at beginning of year2014-12-31$450,872
Value of fidelity bond covering the plan2014-12-31$1,000,000
Total contributions received or receivable from participants2014-12-31$32,493
Expenses. Other expenses not covered elsewhere2014-12-31$3,144
Other income received2014-12-31$1,780
Net income (gross income less expenses)2014-12-31$-76,207
Net plan assets at end of year (total assets less liabilities)2014-12-31$374,665
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$450,872
2013 : PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2013 401k financial data
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$32,189
Expenses. Total of all expenses incurred2013-12-31$107,548
Benefits paid (including direct rollovers)2013-12-31$101,404
Total plan assets at end of year2013-12-31$450,872
Total plan assets at beginning of year2013-12-31$526,231
Value of fidelity bond covering the plan2013-12-31$1,000,000
Total contributions received or receivable from participants2013-12-31$29,802
Expenses. Other expenses not covered elsewhere2013-12-31$6,144
Other income received2013-12-31$2,387
Net income (gross income less expenses)2013-12-31$-75,359
Net plan assets at end of year (total assets less liabilities)2013-12-31$450,872
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$526,231
2012 : PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$3,000
Total income from all sources2012-12-31$35,711
Expenses. Total of all expenses incurred2012-12-31$106,387
Benefits paid (including direct rollovers)2012-12-31$103,243
Total plan assets at end of year2012-12-31$526,231
Total plan assets at beginning of year2012-12-31$599,907
Value of fidelity bond covering the plan2012-12-31$1,000,000
Total contributions received or receivable from participants2012-12-31$31,902
Expenses. Other expenses not covered elsewhere2012-12-31$3,144
Other income received2012-12-31$3,809
Net income (gross income less expenses)2012-12-31$-70,676
Net plan assets at end of year (total assets less liabilities)2012-12-31$526,231
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$596,907
2011 : PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$3,000
Total plan liabilities at beginning of year2011-12-31$1,703
Total income from all sources2011-12-31$136,869
Expenses. Total of all expenses incurred2011-12-31$105,545
Benefits paid (including direct rollovers)2011-12-31$99,401
Total plan assets at end of year2011-12-31$599,907
Total plan assets at beginning of year2011-12-31$567,285
Value of fidelity bond covering the plan2011-12-31$1,000,000
Total contributions received or receivable from participants2011-12-31$32,322
Expenses. Other expenses not covered elsewhere2011-12-31$6,144
Other income received2011-12-31$4,547
Net income (gross income less expenses)2011-12-31$31,324
Net plan assets at end of year (total assets less liabilities)2011-12-31$596,907
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$565,582
Total contributions received or receivable from employer(s)2011-12-31$100,000
2010 : PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$1,703
Total income from all sources2010-12-31$38,746
Expenses. Total of all expenses incurred2010-12-31$127,031
Benefits paid (including direct rollovers)2010-12-31$120,378
Total plan assets at end of year2010-12-31$567,285
Total plan assets at beginning of year2010-12-31$653,866
Value of fidelity bond covering the plan2010-12-31$1,000,000
Total contributions received or receivable from participants2010-12-31$32,332
Expenses. Other expenses not covered elsewhere2010-12-31$6,653
Other income received2010-12-31$6,414
Net income (gross income less expenses)2010-12-31$-88,285
Net plan assets at end of year (total assets less liabilities)2010-12-31$565,582
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$653,866

Form 5500 Responses for PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN

2016: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – TrustYes
2007-01-01Plan benefit arrangement – InsuranceYes
2006: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – TrustYes
2006-01-01Plan benefit arrangement – InsuranceYes
2005: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01Submission has been amendedNo
2005-01-01This submission is the final filingNo
2005-01-01This return/report is a short plan year return/report (less than 12 months)No
2005-01-01Plan is a collectively bargained planNo
2005-01-01Plan funding arrangement – TrustYes
2005-01-01Plan benefit arrangement – InsuranceYes
2004: PSEA,PSEBA,PSFCU,AND SJPECU RETIREE MEDICAL BENEFITS PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Submission has been amendedNo
2004-01-01This submission is the final filingNo
2004-01-01This return/report is a short plan year return/report (less than 12 months)No
2004-01-01Plan is a collectively bargained planNo
2004-01-01Plan funding arrangement – TrustYes
2004-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN5627M/69435M
Policy instance 1
Insurance contract or identification numberN5627M/69435M
Number of Individuals Covered10
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $92,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number515395
Policy instance 3
Insurance contract or identification number515395
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,300
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 number34344-0001
Policy instance 2
Insurance contract or identification number34344-0001
Number of Individuals Covered5
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $15,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN5627M/69435M
Policy instance 1
Insurance contract or identification numberN5627M/69435M
Number of Individuals Covered10
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $85,204
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 number34344-0001
Policy instance 2
Insurance contract or identification number34344-0001
Number of Individuals Covered5
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $16,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number515395
Policy instance 3
Insurance contract or identification number515395
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-13
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN5627M/69435M
Policy instance 1
Insurance contract or identification numberN5627M/69435M
Number of Individuals Covered10
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $80,556
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 number34344-0001
Policy instance 2
Insurance contract or identification number34344-0001
Number of Individuals Covered5
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $15,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number515395
Policy instance 3
Insurance contract or identification number515395
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN5627M/69435M
Policy instance 1
Insurance contract or identification numberN5627M/69435M
Number of Individuals Covered11
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number515395
Policy instance 3
Insurance contract or identification number515395
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,648
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 number34344
Policy instance 2
Insurance contract or identification number34344
Number of Individuals Covered5
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN5627M/69435M
Policy instance 1
Insurance contract or identification numberN5627M/69435M
Number of Individuals Covered11
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,963
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 number34344
Policy instance 2
Insurance contract or identification number34344
Number of Individuals Covered5
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number515395
Policy instance 3
Insurance contract or identification number515395
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number615045
Policy instance 1
Insurance contract or identification number615045
Number of Individuals Covered11
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number515395
Policy instance 2
Insurance contract or identification number515395
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,760
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 number34344
Policy instance 3
Insurance contract or identification number34344
Number of Individuals Covered5
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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