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MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 401k Plan overview

Plan NameMATRIX SERVICE COMPANY HEALTH BENEFIT PLAN
Plan identification number 501

MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

MATRIX SERVICE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:MATRIX SERVICE COMPANY
Employer identification number (EIN):731352174
NAIC Classification:424700

Additional information about MATRIX SERVICE COMPANY

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2210457

More information about MATRIX SERVICE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01MELISSA K. GILLILAND2023-04-17
5012020-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01HOGANTAYLOR LLP PREPARER
5012016-07-01HOGANTAYLOR LLP PREPARER
5012015-07-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2017-02-16
5012014-07-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2016-04-15
5012013-07-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2015-04-15
5012012-07-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2014-04-15
5012011-07-01HOGANTAYLOR LLP PREPARER
5012010-06-01HOGANTAYLOR LLP PREPARER
5012009-06-01HOGANTAYLOR LLP PREPARER

Plan Statistics for MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN

401k plan membership statisitcs for MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN

Measure Date Value
2021: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-011,943
Total number of active participants reported on line 7a of the Form 55002021-07-011,745
Number of retired or separated participants receiving benefits2021-07-0116
Total of all active and inactive participants2021-07-011,761
2020: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-012,030
Total number of active participants reported on line 7a of the Form 55002020-07-011,934
Number of retired or separated participants receiving benefits2020-07-0196
Total of all active and inactive participants2020-07-012,030
2019: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-011,753
Total number of active participants reported on line 7a of the Form 55002019-07-011,519
Number of retired or separated participants receiving benefits2019-07-0182
Total of all active and inactive participants2019-07-011,601
2018: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-011,898
Total number of active participants reported on line 7a of the Form 55002018-07-011,760
Number of retired or separated participants receiving benefits2018-07-0169
Total of all active and inactive participants2018-07-011,829
2017: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-011,623
Total number of active participants reported on line 7a of the Form 55002017-07-011,649
Number of retired or separated participants receiving benefits2017-07-0117
Total of all active and inactive participants2017-07-011,666
Total participants2017-07-011,666
2016: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-011,254
Total number of active participants reported on line 7a of the Form 55002016-07-011,402
Number of retired or separated participants receiving benefits2016-07-0196
Total of all active and inactive participants2016-07-011,498
Total participants2016-07-011,498
2015: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-012,445
Total number of active participants reported on line 7a of the Form 55002015-07-012,214
Number of retired or separated participants receiving benefits2015-07-0134
Total of all active and inactive participants2015-07-012,248
Total participants2015-07-012,248
2014: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-011,300
Total number of active participants reported on line 7a of the Form 55002014-07-011,003
Number of retired or separated participants receiving benefits2014-07-0142
Total of all active and inactive participants2014-07-011,045
Total participants2014-07-011,045
2013: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-011,634
Total number of active participants reported on line 7a of the Form 55002013-07-011,704
Number of retired or separated participants receiving benefits2013-07-0144
Total of all active and inactive participants2013-07-011,748
Total participants2013-07-011,748
2012: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01938
Total number of active participants reported on line 7a of the Form 55002012-07-011,291
Total of all active and inactive participants2012-07-011,291
Total participants2012-07-011,291
2011: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01770
Total number of active participants reported on line 7a of the Form 55002011-07-01938
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01938
Total participants2011-07-01938
2010: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01669
Total number of active participants reported on line 7a of the Form 55002010-06-01658
Number of retired or separated participants receiving benefits2010-06-010
Number of other retired or separated participants entitled to future benefits2010-06-010
Total of all active and inactive participants2010-06-01658
2009: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01811
Total number of active participants reported on line 7a of the Form 55002009-06-01651
Number of retired or separated participants receiving benefits2009-06-010
Number of other retired or separated participants entitled to future benefits2009-06-010
Total of all active and inactive participants2009-06-01651

Form 5500 Responses for MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN

2021: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedYes
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – General assets of the sponsorYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – General assets of the sponsorYes
2009: MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – General assets of the sponsorYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 7
Insurance contract or identification number8768451
Number of Individuals Covered22
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $18,046
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,046
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number36348
Policy instance 1
Insurance contract or identification number36348
Number of Individuals Covered7
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $3,020
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,020
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691900
Policy instance 2
Insurance contract or identification number021691900
Number of Individuals Covered29
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 3
Insurance contract or identification number1500693
Number of Individuals Covered146
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $2,173
Total amount of fees paid to insurance companyUSD $517
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $27,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,173
Amount paid for insurance broker fees131
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL405520
Policy instance 4
Insurance contract or identification number4EL405520
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $732
Other welfare benefits providedBUSINESS TRAVEL MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $4,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $732
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12238158
Policy instance 5
Insurance contract or identification number12238158
Number of Individuals Covered1046
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $5,569
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $232,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,569
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 6
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered453
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number2116200
Policy instance 16
Insurance contract or identification number2116200
Number of Individuals Covered74
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $418,109
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 number226560
Policy instance 8
Insurance contract or identification number226560
Number of Individuals Covered122
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $736,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 9
Insurance contract or identification numberLK 965371
Number of Individuals Covered948
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of fees paid to insurance companyUSD $4,529
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $287,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4529
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 15
Insurance contract or identification numberVDT962348
Number of Individuals Covered326
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of fees paid to insurance companyUSD $2,990
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $179,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2990
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967877
Policy instance 14
Insurance contract or identification numberFLX967877
Number of Individuals Covered3465
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of fees paid to insurance companyUSD $9,136
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $571,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees9136
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberG9038
Policy instance 13
Insurance contract or identification numberG9038
Number of Individuals Covered83
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 12
Insurance contract or identification numberOK 969371
Number of Individuals Covered2198
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of fees paid to insurance companyUSD $2,647
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $165,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2647
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 11
Insurance contract or identification number67978-0
Number of Individuals Covered576
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $62,246
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $232,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,246
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number600860
Policy instance 10
Insurance contract or identification number600860
Number of Individuals Covered10
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967877
Policy instance 7
Insurance contract or identification numberFLX967877
Number of Individuals Covered3774
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $507,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 6
Insurance contract or identification number67978-0
Number of Individuals Covered765
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $60,565
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $226,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,565
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number36348
Policy instance 5
Insurance contract or identification number36348
Number of Individuals Covered23
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $4,109
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,109
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 3
Insurance contract or identification number8768451
Number of Individuals Covered24
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $4
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691900
Policy instance 2
Insurance contract or identification number021691900
Number of Individuals Covered33
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $211,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 1
Insurance contract or identification numberVDT962348
Number of Individuals Covered358
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number2116200
Policy instance 8
Insurance contract or identification number2116200
Number of Individuals Covered63
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $188,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 9
Insurance contract or identification numberLK 965371
Number of Individuals Covered1005
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $258,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberG9038
Policy instance 10
Insurance contract or identification numberG9038
Number of Individuals Covered55
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 14
Insurance contract or identification number1500693
Number of Individuals Covered145
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $3,122
Total amount of fees paid to insurance companyUSD $681
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $39,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,122
Insurance broker organization code?3
Amount paid for insurance broker fees538
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL405520
Policy instance 16
Insurance contract or identification number4EL405520
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Other welfare benefits providedBUSINESS TRAVEL MEDICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226560
Policy instance 15
Insurance contract or identification number226560
Number of Individuals Covered136
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $549,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 4
Insurance contract or identification numberOK 969371
Number of Individuals Covered2276
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $146,695
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 number600860
Policy instance 11
Insurance contract or identification number600860
Number of Individuals Covered12
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,782
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: 39616 )
Policy contract number12238158
Policy instance 13
Insurance contract or identification number12238158
Number of Individuals Covered1137
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $4,577
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $243,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,577
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 12
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered595
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 10
Insurance contract or identification numberLK 965371
Number of Individuals Covered325
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $217,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 9
Insurance contract or identification number1500693
Number of Individuals Covered146
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,884
Total amount of fees paid to insurance companyUSD $536
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $54,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,269
Insurance broker organization code?3
Amount paid for insurance broker fees484
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 11
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered718
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberG8264
Policy instance 14
Insurance contract or identification numberG8264
Number of Individuals Covered70
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 12
Insurance contract or identification numberVDT962348
Number of Individuals Covered374
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $159,776
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 number226560
Policy instance 13
Insurance contract or identification number226560
Number of Individuals Covered148
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $884,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL405520
Policy instance 8
Insurance contract or identification number4EL405520
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $732
Other welfare benefits providedBUSINESS TRAVEL MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $4,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $732
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 7
Insurance contract or identification number67978-0
Number of Individuals Covered573
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $62,535
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $245,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,535
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 6
Insurance contract or identification number8768451
Number of Individuals Covered22
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $20,171
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,169
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number600860
Policy instance 5
Insurance contract or identification number600860
Number of Individuals Covered14
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,824
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: 39616 )
Policy contract number12238158
Policy instance 4
Insurance contract or identification number12238158
Number of Individuals Covered1215
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,792
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $277,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,792
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967877
Policy instance 3
Insurance contract or identification numberFLX967877
Number of Individuals Covered3189
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $693,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691900
Policy instance 2
Insurance contract or identification number021691900
Number of Individuals Covered36
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $280,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 1
Insurance contract or identification numberOK 969371
Number of Individuals Covered1908
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $201,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number2116200
Policy instance 15
Insurance contract or identification number2116200
Number of Individuals Covered29
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,766
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 number36348
Policy instance 16
Insurance contract or identification number36348
Number of Individuals Covered24
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $6,858
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,858
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 2
Insurance contract or identification number1500693
Number of Individuals Covered146
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,884
Total amount of fees paid to insurance companyUSD $536
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $54,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberG8264
Policy instance 11
Insurance contract or identification numberG8264
Number of Individuals Covered70
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,637
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: 39616 )
Policy contract number12238158
Policy instance 12
Insurance contract or identification number12238158
Number of Individuals Covered1215
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,792
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $277,368
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 number36348
Policy instance 13
Insurance contract or identification number36348
Number of Individuals Covered24
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $6,858
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number2116200
Policy instance 14
Insurance contract or identification number2116200
Number of Individuals Covered29
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,766
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 number226560
Policy instance 10
Insurance contract or identification number226560
Number of Individuals Covered148
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $884,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 16
Insurance contract or identification numberOK 969371
Number of Individuals Covered1908
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $201,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691900
Policy instance 1
Insurance contract or identification number021691900
Number of Individuals Covered36
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $280,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 15
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered718
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 9
Insurance contract or identification number67978-0
Number of Individuals Covered573
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $62,535
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $245,265
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 number600860
Policy instance 8
Insurance contract or identification number600860
Number of Individuals Covered14
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 7
Insurance contract or identification numberVDT962348
Number of Individuals Covered374
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $159,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 6
Insurance contract or identification numberLK 965371
Number of Individuals Covered325
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $217,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 5
Insurance contract or identification number8768451
Number of Individuals Covered22
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $20,171
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL405520
Policy instance 4
Insurance contract or identification number4EL405520
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $732
Other welfare benefits providedBUSINESS TRAVEL MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $4,883
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 number226560
Policy instance 4
Insurance contract or identification number226560
Number of Individuals Covered201
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,173,564
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 number600860
Policy instance 12
Insurance contract or identification number600860
Number of Individuals Covered20
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $145,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 11
Insurance contract or identification numberOK 969371
Number of Individuals Covered3005
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of fees paid to insurance companyUSD $3,312
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $238,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3312
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 10
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered817
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 1
Insurance contract or identification number1500693
Number of Individuals Covered159
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $4,022
Total amount of fees paid to insurance companyUSD $677
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $37,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,022
Insurance broker organization code?3
Amount paid for insurance broker fees446
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12238158
Policy instance 2
Insurance contract or identification number12238158
Number of Individuals Covered1461
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $5,306
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $331,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,306
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number36348
Policy instance 3
Insurance contract or identification number36348
Number of Individuals Covered31
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $5,903
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,903
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 5
Insurance contract or identification numberLK 965371
Number of Individuals Covered1264
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of fees paid to insurance companyUSD $3,657
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $264,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3657
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 6
Insurance contract or identification numberVDT962348
Number of Individuals Covered409
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of fees paid to insurance companyUSD $2,612
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $192,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2612
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 7
Insurance contract or identification number67978-0
Number of Individuals Covered761
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $1,567
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $271,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,567
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967877
Policy instance 8
Insurance contract or identification numberFLX967877
Number of Individuals Covered4587
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of fees paid to insurance companyUSD $11,155
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $882,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11155
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691300
Policy instance 9
Insurance contract or identification number021691300
Number of Individuals Covered54
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $388,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 12
Insurance contract or identification number67978-0
Number of Individuals Covered643
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $4,948
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $284,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,948
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number600860
Policy instance 11
Insurance contract or identification number600860
Number of Individuals Covered28
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $163,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691300
Policy instance 10
Insurance contract or identification number021691300
Number of Individuals Covered31
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $228,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 1
Insurance contract or identification numberOK 969371
Number of Individuals Covered2860
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of fees paid to insurance companyUSD $3,444
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $211,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3444
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 2
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered849
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 3
Insurance contract or identification numberVDT962348
Number of Individuals Covered422
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of fees paid to insurance companyUSD $2,679
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $161,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2679
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 4
Insurance contract or identification numberLK 965371
Number of Individuals Covered1425
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of fees paid to insurance companyUSD $4,607
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $254,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4607
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226560
Policy instance 5
Insurance contract or identification number226560
Number of Individuals Covered242
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,142,680
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 number36348
Policy instance 6
Insurance contract or identification number36348
Number of Individuals Covered33
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $6,106
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $227,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,106
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 7
Insurance contract or identification number1500693
Number of Individuals Covered165
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $3,584
Total amount of fees paid to insurance companyUSD $706
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $32,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,285
Insurance broker organization code?3
Amount paid for insurance broker fees611
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967877
Policy instance 8
Insurance contract or identification numberFLX967877
Number of Individuals Covered5469
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of fees paid to insurance companyUSD $11,865
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $731,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11865
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12238158
Policy instance 9
Insurance contract or identification number12238158
Number of Individuals Covered1574
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $5,287
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $323,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,287
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226560
Policy instance 5
Insurance contract or identification number226560
Number of Individuals Covered287
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,261,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT962348
Policy instance 4
Insurance contract or identification numberVDT962348
Number of Individuals Covered435
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of fees paid to insurance companyUSD $5,675
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967877
Policy instance 3
Insurance contract or identification numberFLX967877
Number of Individuals Covered3742
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of fees paid to insurance companyUSD $25,301
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $615,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 2
Insurance contract or identification number1500693
Number of Individuals Covered139
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,216
Total amount of fees paid to insurance companyUSD $588
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $29,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965371
Policy instance 1
Insurance contract or identification numberLK 965371
Number of Individuals Covered1377
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of fees paid to insurance companyUSD $11,922
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $288,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 6
Insurance contract or identification number67978-0
Number of Individuals Covered933
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $7,076
Other welfare benefits providedCRITICAL ILLNESS, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $271,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 7
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered959
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $8,713
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 number600860
Policy instance 8
Insurance contract or identification number600860
Number of Individuals Covered37
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $206,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYNS017
Policy instance 12
Insurance contract or identification numberYNS017
Number of Individuals Covered3873
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $20,229
Welfare Benefit Premiums Paid to CarrierUSD $1,011,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number021691300
Policy instance 13
Insurance contract or identification number021691300
Number of Individuals Covered20
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Are there contracts with allocated funds for individual policies?0
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 $117,007
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 number36348
Policy instance 11
Insurance contract or identification number36348
Number of Individuals Covered40
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,097
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $197,470
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: 39616 )
Policy contract number12238158
Policy instance 10
Insurance contract or identification number12238158
Number of Individuals Covered1465
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $5,223
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $305,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 969371
Policy instance 9
Insurance contract or identification numberOK 969371
Number of Individuals Covered2749
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of fees paid to insurance companyUSD $8,039
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $189,092
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 number600860
Policy instance 1
Insurance contract or identification number600860
Number of Individuals Covered53
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $250,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 2
Insurance contract or identification number67978-0
Number of Individuals Covered1016
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $3,782
Other welfare benefits providedCRITICAL ILLNESS, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $296,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,782
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226560
Policy instance 3
Insurance contract or identification number226560
Number of Individuals Covered386
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,617,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 5
Insurance contract or identification number1500693
Number of Individuals Covered159
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $3,652
Total amount of fees paid to insurance companyUSD $610
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $37,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,652
Amount paid for insurance broker fees610
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 7
Insurance contract or identification number8768451
Number of Individuals Covered21
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $23,826
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,826
Insurance broker organization code?3
Insurance broker nameLOCKTON FINANCIAL ADVISORS LLC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 8
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered561
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,694
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: 95478 )
Policy contract number12238158
Policy instance 9
Insurance contract or identification number12238158
Number of Individuals Covered1433
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $5,081
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $302,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,081
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYNS017
Policy instance 6
Insurance contract or identification numberYNS017
Number of Individuals Covered3740
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,564
Welfare Benefit Premiums Paid to CarrierUSD $1,001,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,564
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649733
Policy instance 4
Insurance contract or identification number649733
Number of Individuals Covered2317
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number36348
Policy instance 10
Insurance contract or identification number36348
Number of Individuals Covered26
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $3,073
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,073
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12238158
Policy instance 3
Insurance contract or identification number12238158
Number of Individuals Covered1594
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $5,278
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $310,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,278
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number600860
Policy instance 1
Insurance contract or identification number600860
Number of Individuals Covered63
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $290,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYNS017
Policy instance 2
Insurance contract or identification numberYNS017
Number of Individuals Covered4161
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
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 BenefitNo
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 $963,948
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 number226560
Policy instance 4
Insurance contract or identification number226560
Number of Individuals Covered386
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,495,811
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 number36348
Policy instance 5
Insurance contract or identification number36348
Number of Individuals Covered40
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $3,022
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,022
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649733
Policy instance 7
Insurance contract or identification number649733
Number of Individuals Covered2761
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 8
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered608
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $8,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 9
Insurance contract or identification number1500693
Number of Individuals Covered181
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $3,560
Total amount of fees paid to insurance companyUSD $500
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $36,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,560
Amount paid for insurance broker fees500
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION, NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 10
Insurance contract or identification number67978-0
Number of Individuals Covered950
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,107
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 BenefitNo
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
Other welfare benefits providedCRITICAL ILLNESS AND ACCIDENT
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 $271,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,107
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 6
Insurance contract or identification number8768451
Number of Individuals Covered22
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $20,082
Total amount of fees paid to insurance companyUSD $419
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,082
Amount paid for insurance broker fees419
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker organization code?3
Insurance broker nameLOCKTON FINANCIAL ADVISORS LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 137035
Policy instance 5
Insurance contract or identification numberGL 137035
Number of Individuals Covered2115
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $23,135
Total amount of fees paid to insurance companyUSD $800
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $1,349,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,135
Amount paid for insurance broker fees800
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8768451
Policy instance 4
Insurance contract or identification number8768451
Number of Individuals Covered15
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $29,396
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,396
Insurance broker organization code?3
Insurance broker nameLOCKTON FINANCIAL ADVISORS LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number600860
Policy instance 3
Insurance contract or identification number600860
Number of Individuals Covered73
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $214,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67978-0
Policy instance 1
Insurance contract or identification number67978-0
Number of Individuals Covered689
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $9,626
Health Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $216,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,626
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12238158
Policy instance 2
Insurance contract or identification number12238158
Number of Individuals Covered1414
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $4,931
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $269,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,931
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number36348
Policy instance 8
Insurance contract or identification number36348
Number of Individuals Covered30
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,790
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 $90,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,790
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 6
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered604
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $8,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYNS017
Policy instance 7
Insurance contract or identification numberYNS017
Number of Individuals Covered3617
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $945,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 9
Insurance contract or identification number1500693
Number of Individuals Covered143
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,249
Total amount of fees paid to insurance companyUSD $463
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $34,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,124
Insurance broker organization code?3
Amount paid for insurance broker fees463
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameLOCKTON COMPANIES, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226560
Policy instance 10
Insurance contract or identification number226560
Number of Individuals Covered363
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,189,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYNS017
Policy instance 2
Insurance contract or identification numberYNS017
Number of Individuals Covered3378
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $684,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameMERCER HEALTH & BENEFITS LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number600860
Policy instance 3
Insurance contract or identification number600860
Number of Individuals Covered48
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $157,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-102
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226560
Policy instance 4
Insurance contract or identification number226560
Number of Individuals Covered347
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,239,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees-58
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number36348
Policy instance 5
Insurance contract or identification number36348
Number of Individuals Covered33
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,187
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,187
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1500693
Policy instance 6
Insurance contract or identification number1500693
Number of Individuals Covered121
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,650
Total amount of fees paid to insurance companyUSD $265
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $26,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,650
Insurance broker organization code?3
Amount paid for insurance broker fees26
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker nameLOCKTON COMPANIES, LLC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009102601
Policy instance 7
Insurance contract or identification numberGTP0009102601
Number of Individuals Covered488
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $8,724
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: 95478 )
Policy contract number12238158
Policy instance 8
Insurance contract or identification number12238158
Number of Individuals Covered1291
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $5,566
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $250,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $989
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number02209
Policy instance 1
Insurance contract or identification number02209
Number of Individuals Covered321
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $34,460
Health Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $107,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,965
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 137035
Policy instance 9
Insurance contract or identification numberGL 137035
Number of Individuals Covered2128
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $34,021
Total amount of fees paid to insurance companyUSD $1,071
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,188,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,021
Amount paid for insurance broker fees1071
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYNS017
Policy instance 1
Insurance contract or identification numberYNS017
Number of Individuals Covered2936
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $27,948
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $544,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberYNS017
Policy instance 1
Insurance contract or identification numberYNS017
Number of Individuals Covered2806
Insurance policy start date2010-06-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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
Other welfare benefits providedSTOP LOSS
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 $336,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberYNS017
Policy instance 1
Insurance contract or identification numberYNS017
Number of Individuals Covered2017
Insurance policy start date2010-06-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $20,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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