401k Plan data: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC plan

MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 401k Plan overview

Plan Name	MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC
Plan identification number	501

MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC Benefits

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

401k Sponsoring company profile

TEG HOTELS LLC has sponsored the creation of one or more 401k plans.

Company Name: TEG HOTELS LLC

Employer identification number (EIN): 870758273

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 DAVID ELMORE DAVID ELMORE 2018-02-27
501 2016-01-01 DAVID ELMORE DAVID ELMORE 2017-09-05
501 2015-01-01 DAVID ELMORE DAVID ELMORE 2016-09-28
501 2014-01-01 DAVID ELMORE DAVID ELMORE 2015-10-05
501 2013-01-01 DAVID ELMORE DAVID ELMORE 2014-05-02
501 2012-01-01 DAVID ELMORE DAVID ELMORE 2013-05-31
501 2011-01-01 DAVID ELMORE DAVID ELMORE 2012-05-25
501 2009-01-01 DAVID ELMORE DAVID ELMORE 2010-10-06

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	DAVID ELMORE	DAVID ELMORE	2018-02-27
501	2016-01-01	DAVID ELMORE	DAVID ELMORE	2017-09-05
501	2015-01-01	DAVID ELMORE	DAVID ELMORE	2016-09-28
501	2014-01-01	DAVID ELMORE	DAVID ELMORE	2015-10-05
501	2013-01-01	DAVID ELMORE	DAVID ELMORE	2014-05-02
501	2012-01-01	DAVID ELMORE	DAVID ELMORE	2013-05-31
501	2011-01-01	DAVID ELMORE	DAVID ELMORE	2012-05-25
501	2009-01-01	DAVID ELMORE	DAVID ELMORE	2010-10-06

Plan Statistics for MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC

401k plan membership statisitcs for MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC

Measure Date Value
2022: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2022 401k membership
Total participants, beginning-of-year 2022-01-01 269
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 255
Total of all active and inactive participants 2022-01-01 255
2021: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2021 401k membership
Total participants, beginning-of-year 2021-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 269
Total of all active and inactive participants 2021-01-01 269
2020: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2020 401k membership
Total participants, beginning-of-year 2020-01-01 398
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 279
Total of all active and inactive participants 2020-01-01 279
2019: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2019 401k membership
Total participants, beginning-of-year 2019-01-01 305
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 398
Total of all active and inactive participants 2019-01-01 398
2018: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2018 401k membership
Total participants, beginning-of-year 2018-01-01 298
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 305
Total of all active and inactive participants 2018-01-01 305
2017: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2017 401k membership
Total participants, beginning-of-year 2017-01-01 404
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 298
Total of all active and inactive participants 2017-01-01 298
2016: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2016 401k membership
Total participants, beginning-of-year 2016-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 404
Total of all active and inactive participants 2016-01-01 404
2015: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2015 401k membership
Total participants, beginning-of-year 2015-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 34
Total of all active and inactive participants 2015-01-01 34
2014: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2014 401k membership
Total participants, beginning-of-year 2014-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 35
Total of all active and inactive participants 2014-01-01 35
2013: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2013 401k membership
Total participants, beginning-of-year 2013-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 31
Total of all active and inactive participants 2013-01-01 31
2012: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2012 401k membership
Total participants, beginning-of-year 2012-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 31
Total of all active and inactive participants 2012-01-01 31
2011: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2011 401k membership
Total participants, beginning-of-year 2011-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 208
Total of all active and inactive participants 2011-01-01 208
2009: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2009 401k membership
Total participants, beginning-of-year 2009-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 199
Total of all active and inactive participants 2009-01-01 199

Measure	Date	Value
2022: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2022 401k membership
Total participants, beginning-of-year	2022-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	255
Total of all active and inactive participants	2022-01-01	255
2021: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	269
Total of all active and inactive participants	2021-01-01	269
2020: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	398
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	279
Total of all active and inactive participants	2020-01-01	279
2019: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2019 401k membership
Total participants, beginning-of-year	2019-01-01	305
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	398
Total of all active and inactive participants	2019-01-01	398
2018: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2018 401k membership
Total participants, beginning-of-year	2018-01-01	298
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	305
Total of all active and inactive participants	2018-01-01	305
2017: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2017 401k membership
Total participants, beginning-of-year	2017-01-01	404
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	298
Total of all active and inactive participants	2017-01-01	298
2016: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2016 401k membership
Total participants, beginning-of-year	2016-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	404
Total of all active and inactive participants	2016-01-01	404
2015: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2015 401k membership
Total participants, beginning-of-year	2015-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	34
Total of all active and inactive participants	2015-01-01	34
2014: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2014 401k membership
Total participants, beginning-of-year	2014-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	35
Total of all active and inactive participants	2014-01-01	35
2013: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2013 401k membership
Total participants, beginning-of-year	2013-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	31
Total of all active and inactive participants	2013-01-01	31
2012: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	31
Total of all active and inactive participants	2012-01-01	31
2011: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	208
Total of all active and inactive participants	2011-01-01	208
2009: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2009 401k membership
Total participants, beginning-of-year	2009-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	199
Total of all active and inactive participants	2009-01-01	199

Form 5500 Responses for MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC

2022: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: MEDICAL PLAN FOR THE EMPLOYEES OF TEG HOTELS LLC 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	151
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	36
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	36
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	4
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	28
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	33
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	4
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	36
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	160
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	36
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	23
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	180
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	4
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	36
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	36
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	35
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	85
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	11
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	85
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	182
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	86
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	87
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50007064

Policy instance

Insurance contract or identification number	50007064
Number of Individuals Covered	87
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	10
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	28
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	23
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	10
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	26
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	9
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	27
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	4
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

60874-1

Policy instance

Insurance contract or identification number	60874-1
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	3
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

60874-2

Policy instance

Insurance contract or identification number	60874-2
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	28
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	20
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	29
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

60874-2

Policy instance

Insurance contract or identification number	60874-2
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

60874-1

Policy instance

Insurance contract or identification number	60874-1
Number of Individuals Covered	159
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

60874-2

Policy instance

Insurance contract or identification number	60874-2
Number of Individuals Covered	0
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-1

Policy instance

Insurance contract or identification number	94160-1
Number of Individuals Covered	29
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

94160-2

Policy instance

Insurance contract or identification number	94160-2
Number of Individuals Covered	0
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2316

Policy instance

Insurance contract or identification number	2316
Number of Individuals Covered	20
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

60874-1

Policy instance

Insurance contract or identification number	60874-1
Number of Individuals Covered	146
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TEG HOTELS LLC
Employer identification number (EIN):	870758273
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels