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AMERICAN AMBULANCE SERVICES HEALTH PLAN 401k Plan overview

Plan NameAMERICAN AMBULANCE SERVICES HEALTH PLAN
Plan identification number 501

AMERICAN AMBULANCE SERVICES HEALTH PLAN Benefits

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

401k Sponsoring company profile

KWPH ENTERPRISES DBA AMERICAN AMBULANCE has sponsored the creation of one or more 401k plans.

Company Name:KWPH ENTERPRISES DBA AMERICAN AMBULANCE
Employer identification number (EIN):942281434
NAIC Classification:621900

Additional information about KWPH ENTERPRISES DBA AMERICAN AMBULANCE

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0734291

More information about KWPH ENTERPRISES DBA AMERICAN AMBULANCE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN AMBULANCE SERVICES HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01BOB ADAMS2023-07-17
5012021-01-01BOB ADAMS2022-08-01
5012020-01-01BOB ADAMS2021-07-15
5012019-01-01BOB ADAMS2020-07-22
5012018-01-01BOB ADAMS2019-08-05
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01ROBERT ADAMS ROBERT ADAMS2013-08-20
5012011-01-01ROBERT ADAMS ROBERT ADAMS2012-08-14
5012010-01-01ROBERT ADAMS ROBERT ADAMS2011-07-15
5012009-01-01ROBERT ADAMS ROBERT ADAMS2011-07-15
5012009-01-01ROBERT ADAMS ROBERT ADAMS2010-07-23

Plan Statistics for AMERICAN AMBULANCE SERVICES HEALTH PLAN

401k plan membership statisitcs for AMERICAN AMBULANCE SERVICES HEALTH PLAN

Measure Date Value
2022: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01750
Total number of active participants reported on line 7a of the Form 55002022-01-01682
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01682
Number of employers contributing to the scheme2022-01-010
2021: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01647
Total number of active participants reported on line 7a of the Form 55002021-01-01750
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01750
Number of employers contributing to the scheme2021-01-010
2020: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01650
Total number of active participants reported on line 7a of the Form 55002020-01-01647
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01647
Number of employers contributing to the scheme2020-01-010
2019: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01628
Total number of active participants reported on line 7a of the Form 55002019-01-01650
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01650
Number of employers contributing to the scheme2019-01-010
2018: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01621
Total number of active participants reported on line 7a of the Form 55002018-01-01628
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01628
Number of employers contributing to the scheme2018-01-010
2017: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01881
Total number of active participants reported on line 7a of the Form 55002017-01-01969
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01969
2016: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01571
Total number of active participants reported on line 7a of the Form 55002016-01-01881
Total of all active and inactive participants2016-01-01881
2015: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01611
Total number of active participants reported on line 7a of the Form 55002015-01-01571
Total of all active and inactive participants2015-01-01571
2014: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01928
Total number of active participants reported on line 7a of the Form 55002014-01-01611
Total of all active and inactive participants2014-01-01611
2013: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01873
Total number of active participants reported on line 7a of the Form 55002013-01-01928
Total of all active and inactive participants2013-01-01928
2012: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01434
Total number of active participants reported on line 7a of the Form 55002012-01-01873
Total of all active and inactive participants2012-01-01873
2011: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01438
Total number of active participants reported on line 7a of the Form 55002011-01-01434
Total of all active and inactive participants2011-01-01434
2010: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01401
Total number of active participants reported on line 7a of the Form 55002010-01-01438
Total of all active and inactive participants2010-01-01438
2009: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01290
Total number of active participants reported on line 7a of the Form 55002009-01-01401
Total of all active and inactive participants2009-01-01401
Total participants2009-01-010

Form 5500 Responses for AMERICAN AMBULANCE SERVICES HEALTH PLAN

2022: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: AMERICAN AMBULANCE SERVICES HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CLEVER HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 5
Insurance contract or identification number00
Number of Individuals Covered682
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $53
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTELEHEALTH
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $53
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number494817
Policy instance 4
Insurance contract or identification number494817
Number of Individuals Covered682
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $19,638
Total amount of fees paid to insurance companyUSD $7,163
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $203,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,638
Amount paid for insurance broker fees7163
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
HALCYON BEHAVIORAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberHALCYON
Policy instance 3
Insurance contract or identification numberHALCYON
Number of Individuals Covered750
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $41,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76393
Policy instance 2
Insurance contract or identification number76393
Number of Individuals Covered197
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,680
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,680
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number34862
Policy instance 1
Insurance contract or identification number34862
Number of Individuals Covered182
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $28,311
Total amount of fees paid to insurance companyUSD $616
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $953,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,311
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number34862
Policy instance 1
Insurance contract or identification number34862
Number of Individuals Covered191
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $27,189
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $918,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,189
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76393
Policy instance 2
Insurance contract or identification number76393
Number of Individuals Covered194
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,890
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,890
Amount paid for insurance broker fees0
Insurance broker organization code?3
HALCYON BEHAVIORAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberHALCYON
Policy instance 3
Insurance contract or identification numberHALCYON
Number of Individuals Covered750
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $3,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number494817
Policy instance 4
Insurance contract or identification number494817
Number of Individuals Covered653
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $19,347
Total amount of fees paid to insurance companyUSD $5,883
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $197,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,347
Amount paid for insurance broker fees5883
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number494817
Policy instance 4
Insurance contract or identification number494817
Number of Individuals Covered647
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $30,724
Total amount of fees paid to insurance companyUSD $1,924
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $232,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,724
Amount paid for insurance broker fees1924
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
AVANTE BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract numberAVANTE
Policy instance 3
Insurance contract or identification numberAVANTE
Number of Individuals Covered650
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $8,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76393
Policy instance 2
Insurance contract or identification number76393
Number of Individuals Covered214
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,993
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,993
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number34862
Policy instance 1
Insurance contract or identification number34862
Number of Individuals Covered209
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $27,736
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $933,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,736
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10134383
Policy instance 4
Insurance contract or identification number10134383
Number of Individuals Covered630
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $26,265
Total amount of fees paid to insurance companyUSD $12,473
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $178,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,265
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
AVANTE BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract numberAVANTE
Policy instance 3
Insurance contract or identification numberAVANTE
Number of Individuals Covered650
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $8,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76393
Policy instance 2
Insurance contract or identification number76393
Number of Individuals Covered249
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,351
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,541
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number34862
Policy instance 1
Insurance contract or identification number34862
Number of Individuals Covered254
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $31,319
Total amount of fees paid to insurance companyUSD $2
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $961,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,319
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number903822
Policy instance 2
Insurance contract or identification number903822
Number of Individuals Covered969
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $99,077
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,588,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $99,077
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDER MANOUEL INS. AND FIN. SVCES.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76393
Policy instance 3
Insurance contract or identification number76393
Number of Individuals Covered305
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,108
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,108
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDER MANOUEL INS. AND FIN. SVCES.
AVANTE BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract numberA99
Policy instance 4
Insurance contract or identification numberA99
Number of Individuals Covered646
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberMG-115
Policy instance 5
Insurance contract or identification numberMG-115
Number of Individuals Covered78
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,039
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,039
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDER MANOUEL INS. AND FIN. SVCES.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10134383
Policy instance 6
Insurance contract or identification number10134383
Number of Individuals Covered622
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $27,061
Total amount of fees paid to insurance companyUSD $5,225
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $189,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,284
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOVERRIDE, OVERRIDES
Insurance broker nameDER MANOUEL INS. AND FIN SVCES.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number34862
Policy instance 1
Insurance contract or identification number34862
Number of Individuals Covered226
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $31,546
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $969,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,546
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDER MANOUEL INS. AND FIN. SVCES.

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