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| Plan Name | AT-BAY, INC. HEALTH WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AT-BAY, INC. |
| Employer identification number (EIN): | 813719687 |
| NAIC Classification: | 524210 |
| NAIC Description: | Insurance Agencies and Brokerages |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2024-01-01 | HEIDI ARCILLA | |||
| 501 | 2022-10-01 | HEIDI ARCILLA | 2023-09-13 |
| 2022: AT-BAY, INC. HEALTH WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | First time form 5500 has been submitted | Yes |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||
| Policy contract number | 730165 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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