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CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 401k Plan overview

Plan NameCALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST
Plan identification number 501

CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

TRUSTEES OF THE CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS BENEF has sponsored the creation of one or more 401k plans.

Company Name:TRUSTEES OF THE CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS BENEF
Employer identification number (EIN):816716859
NAIC Classification:713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01DARRON RISHWAIN2023-10-10
5012021-01-01LARRY MARX2022-10-10
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01LARRY MARX
5012016-01-01LARRY MARX
5012015-05-01LARRY MARX

Plan Statistics for CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST

401k plan membership statisitcs for CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST

Measure Date Value
2022: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-0122,968
Total number of active participants reported on line 7a of the Form 55002022-01-0136,578
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0179
Total of all active and inactive participants2022-01-0136,657
2021: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-0118,080
Total number of active participants reported on line 7a of the Form 55002021-01-0122,051
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-01103
Total of all active and inactive participants2021-01-0122,154
2020: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-0116,290
Total number of active participants reported on line 7a of the Form 55002020-01-0117,280
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-01123
Total of all active and inactive participants2020-01-0117,403
2019: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-0111,751
Total number of active participants reported on line 7a of the Form 55002019-01-0116,374
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0170
Total of all active and inactive participants2019-01-0116,444
2018: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-018,468
Total number of active participants reported on line 7a of the Form 55002018-01-0111,555
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0177
Total of all active and inactive participants2018-01-0111,632
2017: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-016,790
Total number of active participants reported on line 7a of the Form 55002017-01-018,264
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0150
Total of all active and inactive participants2017-01-018,314
2016: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-015,615
Total number of active participants reported on line 7a of the Form 55002016-01-016,756
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0134
Total of all active and inactive participants2016-01-016,790
2015: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2015 401k membership
Total participants, beginning-of-year2015-05-014,440
Total number of active participants reported on line 7a of the Form 55002015-05-014,730
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-0137
Total of all active and inactive participants2015-05-014,767

Financial Data on CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST

Measure Date Value
2022 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$359,565
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$918,939
Total income from all sources (including contributions)2022-12-31$98,227,107
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$98,226,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$84,159,499
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$98,225,269
Value of total assets at end of year2022-12-31$397,091
Value of total assets at beginning of year2022-12-31$955,767
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$14,066,910
Total interest from all sources2022-12-31$1,838
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$813,367
Participant contributions at end of year2022-12-31$62,853
Participant contributions at beginning of year2022-12-31$410,004
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$698
Value of net assets at end of year (total assets less liabilities)2022-12-31$37,526
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$36,828
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$334,238
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$545,763
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$545,763
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$1,838
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$84,159,499
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$97,411,902
Contract administrator fees2022-12-31$14,066,910
Liabilities. Value of benefit claims payable at end of year2022-12-31$359,565
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$918,939
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2022-12-31222027092
2021 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$918,939
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$251,554
Total income from all sources (including contributions)2021-12-31$88,452,240
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$88,429,894
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$77,040,059
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$88,451,753
Value of total assets at end of year2021-12-31$955,767
Value of total assets at beginning of year2021-12-31$266,036
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$11,389,835
Total interest from all sources2021-12-31$487
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,405,826
Participant contributions at end of year2021-12-31$410,004
Participant contributions at beginning of year2021-12-31$156,072
Total non interest bearing cash at beginning of year2021-12-31$56,262
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$22,346
Value of net assets at end of year (total assets less liabilities)2021-12-31$36,828
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$14,482
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$545,763
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$53,702
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$53,702
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$487
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$77,040,059
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$87,045,927
Contract administrator fees2021-12-31$11,389,835
Liabilities. Value of benefit claims payable at end of year2021-12-31$918,939
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$251,554
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2021-12-31222027092
2020 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$251,554
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$527,575
Total income from all sources (including contributions)2020-12-31$82,579,395
Total of all expenses incurred2020-12-31$82,575,008
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$73,130,136
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$82,574,448
Value of total assets at end of year2020-12-31$266,036
Value of total assets at beginning of year2020-12-31$537,670
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$9,444,872
Total interest from all sources2020-12-31$4,947
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$984,745
Participant contributions at end of year2020-12-31$156,072
Participant contributions at beginning of year2020-12-31$40,363
Total non interest bearing cash at end of year2020-12-31$56,262
Total non interest bearing cash at beginning of year2020-12-31$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$4,387
Value of net assets at end of year (total assets less liabilities)2020-12-31$14,482
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$10,095
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$53,702
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$497,304
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$497,304
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$4,947
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$73,130,136
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$81,589,703
Contract administrator fees2020-12-31$9,444,872
Liabilities. Value of benefit claims payable at end of year2020-12-31$251,554
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$527,575
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31LINDQUIST LLP
Accountancy firm EIN2020-12-31522385296
2019 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$527,575
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$475,643
Total income from all sources (including contributions)2019-12-31$78,219,101
Total of all expenses incurred2019-12-31$78,202,782
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$70,375,773
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$78,217,876
Value of total assets at end of year2019-12-31$537,670
Value of total assets at beginning of year2019-12-31$469,419
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$7,827,009
Total interest from all sources2019-12-31$1,225
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$860,334
Participant contributions at end of year2019-12-31$40,363
Participant contributions at beginning of year2019-12-31$334,412
Total non interest bearing cash at end of year2019-12-31$3
Total non interest bearing cash at beginning of year2019-12-31$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$16,319
Value of net assets at end of year (total assets less liabilities)2019-12-31$10,095
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-6,224
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$497,304
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$135,004
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$135,004
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$1,225
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$70,375,773
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$77,357,542
Contract administrator fees2019-12-31$7,827,009
Liabilities. Value of benefit claims payable at end of year2019-12-31$527,575
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$475,643
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31LINDQUIST LLP
Accountancy firm EIN2019-12-31522385296
2018 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$475,643
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$661,525
Total income from all sources (including contributions)2018-12-31$67,350,906
Total of all expenses incurred2018-12-31$67,349,474
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$61,145,024
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$67,349,931
Value of total assets at end of year2018-12-31$469,419
Value of total assets at beginning of year2018-12-31$653,869
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$6,204,450
Total interest from all sources2018-12-31$975
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$562,767
Participant contributions at end of year2018-12-31$334,412
Participant contributions at beginning of year2018-12-31$98,353
Total non interest bearing cash at end of year2018-12-31$3
Total non interest bearing cash at beginning of year2018-12-31$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$1,432
Value of net assets at end of year (total assets less liabilities)2018-12-31$-6,224
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$-7,656
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$135,004
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$555,513
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$555,513
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$975
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$61,145,024
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$66,787,164
Contract administrator fees2018-12-31$6,204,450
Liabilities. Value of benefit claims payable at end of year2018-12-31$475,643
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$661,525
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31LINDQUIST LLP
Accountancy firm EIN2018-12-31522385296
2017 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$661,525
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$40,266
Total income from all sources (including contributions)2017-12-31$57,455,216
Total of all expenses incurred2017-12-31$57,470,536
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$52,360,084
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$57,454,430
Value of total assets at end of year2017-12-31$653,869
Value of total assets at beginning of year2017-12-31$47,930
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$5,110,452
Total interest from all sources2017-12-31$786
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$539,965
Participant contributions at end of year2017-12-31$98,353
Participant contributions at beginning of year2017-12-31$3,287
Total non interest bearing cash at end of year2017-12-31$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-15,320
Value of net assets at end of year (total assets less liabilities)2017-12-31$-7,656
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$7,664
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$555,513
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$44,643
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$44,643
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$786
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$52,360,084
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$56,914,465
Contract administrator fees2017-12-31$5,110,452
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$661,525
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$40,266
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31LINDQUIST LLP
Accountancy firm EIN2017-12-31522385296
2016 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$40,266
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$61,717
Total income from all sources (including contributions)2016-12-31$44,071,033
Total of all expenses incurred2016-12-31$44,068,377
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$40,908,028
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$44,069,465
Value of total assets at end of year2016-12-31$47,930
Value of total assets at beginning of year2016-12-31$66,725
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$3,160,349
Total interest from all sources2016-12-31$1,568
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Participant contributions at end of year2016-12-31$3,287
Participant contributions at beginning of year2016-12-31$61,717
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$2,656
Value of net assets at end of year (total assets less liabilities)2016-12-31$7,664
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$5,008
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$44,643
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$5,008
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$5,008
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$1,568
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$40,908,028
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$44,069,465
Contract administrator fees2016-12-31$3,160,349
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Liabilities. Value of benefit claims payable at end of year2016-12-31$40,266
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$61,717
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31LINDQUIST LLP
Accountancy firm EIN2016-12-31522385296
2015 : CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2015 401k financial data
Total transfer of assets to this plan2015-12-31$4,013
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$61,717
Total income from all sources (including contributions)2015-12-31$23,907,375
Total of all expenses incurred2015-12-31$23,906,380
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$22,303,400
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$23,906,380
Value of total assets at end of year2015-12-31$66,725
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$1,602,980
Total interest from all sources2015-12-31$995
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Participant contributions at end of year2015-12-31$61,717
Administrative expenses (other) incurred2015-12-31$171,050
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$995
Value of net assets at end of year (total assets less liabilities)2015-12-31$5,008
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$5,008
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$995
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$22,303,400
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$23,906,380
Contract administrator fees2015-12-31$1,431,930
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Liabilities. Value of benefit claims payable at end of year2015-12-31$61,717
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31LINDQUIST LLP
Accountancy firm EIN2015-12-31522385296

Form 5500 Responses for CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST

2022: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: CALIFORNIA ASSOCIATION OF GOLF AND PRIVATE CLUBS WELFARE BENEFIT TRUST 2015 form 5500 responses
2015-05-01Type of plan entityMulitple employer plan
2015-05-01First time form 5500 has been submittedYes
2015-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-05-01Plan funding arrangement – TrustYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603161
Policy instance 5
Insurance contract or identification number603161
Number of Individuals Covered1060
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $589,786
Total amount of fees paid to insurance companyUSD $0
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 $7,763,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $589,786
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number230767
Policy instance 4
Insurance contract or identification number230767
Number of Individuals Covered1684
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $723,842
Total amount of fees paid to insurance companyUSD $0
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 $9,458,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $723,842
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275316
Policy instance 3
Insurance contract or identification number275316
Number of Individuals Covered17928
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,968,398
Total amount of fees paid to insurance companyUSD $35,009
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 BenefitYes
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 providedBEHAVIORAL HEALTH
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 $29,386,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,968,398
Amount paid for insurance broker fees35009
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION, AND TRAINING
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number275316
Policy instance 2
Insurance contract or identification number275316
Number of Individuals Covered3767
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $725,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number275316
Policy instance 1
Insurance contract or identification number275316
Number of Individuals Covered18295
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitYes
Life Insurance Welfare BenefitYes
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 $29,462,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number275316
Policy instance 1
Insurance contract or identification number275316
Number of Individuals Covered15696
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitYes
Life Insurance Welfare BenefitYes
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 $26,322,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number275316
Policy instance 2
Insurance contract or identification number275316
Number of Individuals Covered2974
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $561,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275316
Policy instance 3
Insurance contract or identification number275316
Number of Individuals Covered16818
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,578,247
Total amount of fees paid to insurance companyUSD $99,451
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 BenefitYes
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 providedBEHAVIORAL HEALTH
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 $31,461,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,578,247
Amount paid for insurance broker fees99451
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION, AND TRAINING
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number230767
Policy instance 4
Insurance contract or identification number230767
Number of Individuals Covered1775
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $631,722
Total amount of fees paid to insurance companyUSD $0
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 $9,061,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $631,722
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603161
Policy instance 5
Insurance contract or identification number603161
Number of Individuals Covered1059
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $528,448
Total amount of fees paid to insurance companyUSD $0
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 $7,578,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $528,448
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603161
Policy instance 5
Insurance contract or identification number603161
Number of Individuals Covered1164
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $580,163
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,854,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $580,163
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number230767
Policy instance 4
Insurance contract or identification number230767
Number of Individuals Covered1834
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $695,522
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,042,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $695,522
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275316
Policy instance 3
Insurance contract or identification number275316
Number of Individuals Covered15960
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,657,077
Total amount of fees paid to insurance companyUSD $216,501
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $31,206,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,657,077
Amount paid for insurance broker fees216501
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION, AND TRAINING
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number275316
Policy instance 2
Insurance contract or identification number275316
Number of Individuals Covered13236
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $434,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number275316
Policy instance 1
Insurance contract or identification number275316
Number of Individuals Covered14383
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,102,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number723847
Policy instance 6
Insurance contract or identification number723847
Number of Individuals Covered4614
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $404,228
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,049,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $404,228
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603161
Policy instance 5
Insurance contract or identification number603161
Number of Individuals Covered1330
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $567,065
Total amount of fees paid to insurance companyUSD $3,955
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,648,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $567,065
Amount paid for insurance broker fees3955
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number230767
Policy instance 4
Insurance contract or identification number230767
Number of Individuals Covered2058
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $655,978
Total amount of fees paid to insurance companyUSD $8,495
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,374,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $655,978
Amount paid for insurance broker fees8495
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275316
Policy instance 3
Insurance contract or identification number275316
Number of Individuals Covered8828
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,473,284
Total amount of fees paid to insurance companyUSD $116,662
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $27,831,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,473,284
Amount paid for insurance broker fees116662
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION & TRAINING
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number275316
Policy instance 2
Insurance contract or identification number275316
Number of Individuals Covered11821
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $444,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number275316
Policy instance 1
Insurance contract or identification number275316
Number of Individuals Covered13988
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,786,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number275316
Policy instance 1
Insurance contract or identification number275316
Number of Individuals Covered10719
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,304,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number275316
Policy instance 2
Insurance contract or identification number275316
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $310,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275316
Policy instance 3
Insurance contract or identification number275316
Number of Individuals Covered8089
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,420,631
Total amount of fees paid to insurance companyUSD $128,787
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $21,917,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,420,631
Amount paid for insurance broker fees128787
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION, AND TRAINING.
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number230767
Policy instance 4
Insurance contract or identification number230767
Number of Individuals Covered1903
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $607,292
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,983,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $607,292
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603161
Policy instance 5
Insurance contract or identification number603161
Number of Individuals Covered1297
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $476,213
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,399,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $476,213
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number723847
Policy instance 6
Insurance contract or identification number723847
Number of Individuals Covered3463
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $335,686
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,356,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $335,686
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INS SERV
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number723847
Policy instance 6
Insurance contract or identification number723847
Number of Individuals Covered2376
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $253,974
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,539,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $253,974
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603161
Policy instance 5
Insurance contract or identification number603161
Number of Individuals Covered1113
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $263,012
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,339,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $263,012
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number230767
Policy instance 4
Insurance contract or identification number230767
Number of Individuals Covered1438
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $263,856
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,339,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $263,856
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275316
Policy instance 3
Insurance contract or identification number275316
Number of Individuals Covered3058
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,182,670
Total amount of fees paid to insurance companyUSD $11,403
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,899,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,182,670
Amount paid for insurance broker fees11403
Insurance broker organization code?3
Insurance broker nameDUDUM FINANCIAL AND INSURANCE SERVI
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number275316
Policy instance 2
Insurance contract or identification number275316
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $135,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number275316
Policy instance 1
Insurance contract or identification number275316
Number of Individuals Covered4090
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,490,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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