HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 401k Plan overview

Plan Name	HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST
Plan identification number	501

HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Other welfare benefit cover

401k Sponsoring company profile

BOARD OF TRUSTEES, HEALTH CARE EMPLOYEES/EMPLOYER has sponsored the creation of one or more 401k plans.

Company Name:	BOARD OF TRUSTEES, HEALTH CARE EMPLOYEES/EMPLOYER
Employer identification number (EIN):	942356343
NAIC Classification:	525100
NAIC Description:	Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST

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	2019-01-01
501	2018-01-01
501	2017-01-01	ROBERT LI		GEORGE MCHUGH	2018-10-11
501	2016-01-01	SETH SCHAPIRO		GEORGE MCHUGH	2017-10-10
501	2015-01-01	SETH SCHAPIRO		GEORGE MCHUGH	2016-10-13
501	2014-01-01	SETH SCHAPIRO		JOHN OMALLEY	2015-10-15
501	2013-01-01	NORMA GUTIERREZ		JOHN OMALLEY	2014-10-14
501	2012-01-01	REBECCA MALBERG		JOHN OMALLEY	2013-10-15
501	2011-01-01	REBECCA MALBERG		JOHN OMALLEY	2012-10-15
501	2009-01-01	DAVID KRAMER		JOHN OMALLEY	2010-10-13

Plan Statistics for HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST

401k plan membership statisitcs for HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST

Measure	Date	Value
2022: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	25,101
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	25,836
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	25,836
Total participants	2022-01-01	25,836
Number of employers contributing to the scheme	2022-01-01	167
2021: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	25,620
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	25,101
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	25,101
Total participants	2021-01-01	25,101
Number of employers contributing to the scheme	2021-01-01	172
2020: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	23,926
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	25,620
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	25,620
Total participants	2020-01-01	25,620
Number of employers contributing to the scheme	2020-01-01	174
2019: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	23,922
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	23,926
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	23,926
Total participants	2019-01-01	23,926
Number of employers contributing to the scheme	2019-01-01	178
2018: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	27,360
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	23,922
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	23,922
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	23,922
Number of participants with account balances	2018-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
Number of employers contributing to the scheme	2018-01-01	175
2017: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	24,649
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	27,360
Total of all active and inactive participants	2017-01-01	27,360
Total participants	2017-01-01	27,360
Number of employers contributing to the scheme	2017-01-01	178
2016: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	22,743
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	24,649
Total of all active and inactive participants	2016-01-01	24,649
Total participants	2016-01-01	24,649
Number of employers contributing to the scheme	2016-01-01	184
2015: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	25,786
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	22,743
Total of all active and inactive participants	2015-01-01	22,743
Total participants	2015-01-01	22,743
Number of employers contributing to the scheme	2015-01-01	184
2014: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	25,709
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	25,786
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	25,786
Total participants	2014-01-01	25,786
Number of employers contributing to the scheme	2014-01-01	185
2013: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	25,038
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	25,709
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	25,709
Total participants	2013-01-01	25,709
Number of employers contributing to the scheme	2013-01-01	196
2012: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	22,680
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	25,038
Total of all active and inactive participants	2012-01-01	25,038
Total participants	2012-01-01	25,038
Number of employers contributing to the scheme	2012-01-01	197
2011: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	22,978
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	22,680
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	22,680
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	22,680
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
Number of employers contributing to the scheme	2011-01-01	198
2009: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	23,891
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	25,150
Total of all active and inactive participants	2009-01-01	25,150
Total participants	2009-01-01	25,150

Financial Data on HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST

Measure	Date	Value
2022 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$43,812,547
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$38,959,835
Total income from all sources (including contributions)	2022-12-31	$181,222,499
Total of all expenses incurred	2022-12-31	$181,694,970
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$178,572,374
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$181,128,336
Value of total assets at end of year	2022-12-31	$48,670,202
Value of total assets at beginning of year	2022-12-31	$44,289,961
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$3,122,596
Total interest from all sources	2022-12-31	$94,163
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$258,959
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$4,872,686
Participant contributions at end of year	2022-12-31	$405,474
Participant contributions at beginning of year	2022-12-31	$449,556
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$21,739,020
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$22,589,097
Administrative expenses (other) incurred	2022-12-31	$293,009
Liabilities. Value of operating payables at end of year	2022-12-31	$15,518
Liabilities. Value of operating payables at beginning of year	2022-12-31	$45,481
Total non interest bearing cash at end of year	2022-12-31	$462,283
Total non interest bearing cash at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-472,471
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,857,655
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,330,126
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$35,131,271
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$32,162,785
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$32,162,785
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$94,163
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$178,572,374
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$176,255,650
Employer contributions (assets) at end of year	2022-12-31	$12,671,174
Employer contributions (assets) at beginning of year	2022-12-31	$11,677,620
Contract administrator fees	2022-12-31	$2,570,628
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$22,058,009
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$16,325,257
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2022-12-31	952036255
2021 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$38,959,835
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$29,103,214
Total income from all sources (including contributions)	2021-12-31	$174,183,800
Total of all expenses incurred	2021-12-31	$173,934,919
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$171,551,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$174,155,804
Value of total assets at end of year	2021-12-31	$44,289,961
Value of total assets at beginning of year	2021-12-31	$34,184,459
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$2,383,729
Total interest from all sources	2021-12-31	$27,996
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$272,583
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$4,165,220
Participant contributions at end of year	2021-12-31	$449,556
Participant contributions at beginning of year	2021-12-31	$359,078
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$22,589,097
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$13,125,251
Administrative expenses (other) incurred	2021-12-31	$264,848
Liabilities. Value of operating payables at end of year	2021-12-31	$45,481
Liabilities. Value of operating payables at beginning of year	2021-12-31	$28,627
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$81,377
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$248,881
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,330,126
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$5,081,245
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$32,162,785
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$22,104,005
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$22,104,005
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$27,996
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$171,551,190
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$169,990,584
Employer contributions (assets) at end of year	2021-12-31	$11,677,620
Employer contributions (assets) at beginning of year	2021-12-31	$11,639,999
Contract administrator fees	2021-12-31	$1,846,298
Liabilities. Value of benefit claims payable at end of year	2021-12-31	$16,325,257
Liabilities. Value of benefit claims payable at beginning of year	2021-12-31	$15,949,336
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2021-12-31	952036255
2020 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$29,103,214
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$23,302,324
Total income from all sources (including contributions)	2020-12-31	$161,611,160
Total of all expenses incurred	2020-12-31	$160,735,069
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$158,366,676
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$161,577,840
Value of total assets at end of year	2020-12-31	$34,184,459
Value of total assets at beginning of year	2020-12-31	$27,507,478
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,368,393
Total interest from all sources	2020-12-31	$33,320
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$267,475
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$3,102,848
Participant contributions at end of year	2020-12-31	$359,078
Participant contributions at beginning of year	2020-12-31	$253,616
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$13,125,251
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$11,104,814
Administrative expenses (other) incurred	2020-12-31	$200,292
Liabilities. Value of operating payables at end of year	2020-12-31	$28,627
Liabilities. Value of operating payables at beginning of year	2020-12-31	$36,188
Total non interest bearing cash at end of year	2020-12-31	$81,377
Total non interest bearing cash at beginning of year	2020-12-31	$385,960
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$876,091
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$5,081,245
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$4,205,154
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$22,104,005
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$18,791,498
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$18,791,498
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$33,320
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$158,366,676
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$158,474,992
Employer contributions (assets) at end of year	2020-12-31	$11,639,999
Employer contributions (assets) at beginning of year	2020-12-31	$8,076,404
Contract administrator fees	2020-12-31	$1,900,626
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$15,949,336
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$12,161,322
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2020-12-31	952036255
2019 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$23,302,324
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$23,302,324
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$20,331,582
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$20,331,582
Total income from all sources (including contributions)	2019-12-31	$149,766,985
Total income from all sources (including contributions)	2019-12-31	$149,766,985
Total of all expenses incurred	2019-12-31	$149,857,467
Total of all expenses incurred	2019-12-31	$149,857,467
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$147,455,900
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$147,455,900
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$149,711,239
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$149,711,239
Value of total assets at end of year	2019-12-31	$27,507,478
Value of total assets at end of year	2019-12-31	$27,507,478
Value of total assets at beginning of year	2019-12-31	$24,627,218
Value of total assets at beginning of year	2019-12-31	$24,627,218
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,401,567
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,401,567
Total interest from all sources	2019-12-31	$55,746
Total interest from all sources	2019-12-31	$55,746
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$278,227
Administrative expenses professional fees incurred	2019-12-31	$278,227
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$3,153,244
Contributions received from participants	2019-12-31	$3,153,244
Participant contributions at end of year	2019-12-31	$253,616
Participant contributions at end of year	2019-12-31	$253,616
Participant contributions at beginning of year	2019-12-31	$262,935
Participant contributions at beginning of year	2019-12-31	$262,935
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$11,104,814
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$11,104,814
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$8,816,160
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$8,816,160
Administrative expenses (other) incurred	2019-12-31	$200,158
Administrative expenses (other) incurred	2019-12-31	$200,158
Liabilities. Value of operating payables at end of year	2019-12-31	$36,188
Liabilities. Value of operating payables at end of year	2019-12-31	$36,188
Liabilities. Value of operating payables at beginning of year	2019-12-31	$45,958
Liabilities. Value of operating payables at beginning of year	2019-12-31	$45,958
Total non interest bearing cash at end of year	2019-12-31	$385,960
Total non interest bearing cash at end of year	2019-12-31	$385,960
Total non interest bearing cash at beginning of year	2019-12-31	$637,921
Total non interest bearing cash at beginning of year	2019-12-31	$637,921
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-90,482
Value of net income/loss	2019-12-31	$-90,482
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,205,154
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,205,154
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,295,636
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,295,636
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$18,791,498
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$18,791,498
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$16,368,839
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$16,368,839
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$16,368,839
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$16,368,839
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$55,746
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$55,746
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$147,455,900
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$147,455,900
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$146,557,995
Contributions received in cash from employer	2019-12-31	$146,557,995
Employer contributions (assets) at end of year	2019-12-31	$8,076,404
Employer contributions (assets) at end of year	2019-12-31	$8,076,404
Employer contributions (assets) at beginning of year	2019-12-31	$7,357,523
Employer contributions (assets) at beginning of year	2019-12-31	$7,357,523
Contract administrator fees	2019-12-31	$1,923,182
Contract administrator fees	2019-12-31	$1,923,182
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$12,161,322
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$12,161,322
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$11,469,464
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$11,469,464
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm name	2019-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2019-12-31	952036255
Accountancy firm EIN	2019-12-31	952036255
2018 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$20,331,582
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$17,310,914
Total income from all sources (including contributions)	2018-12-31	$145,372,556
Total of all expenses incurred	2018-12-31	$145,181,431
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$142,772,869
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$145,324,223
Value of total assets at end of year	2018-12-31	$24,627,218
Value of total assets at beginning of year	2018-12-31	$21,415,425
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,408,562
Total interest from all sources	2018-12-31	$48,333
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$287,456
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$3,119,577
Participant contributions at end of year	2018-12-31	$262,935
Participant contributions at beginning of year	2018-12-31	$246,452
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$8,816,160
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$7,350,460
Administrative expenses (other) incurred	2018-12-31	$189,775
Liabilities. Value of operating payables at end of year	2018-12-31	$45,958
Liabilities. Value of operating payables at beginning of year	2018-12-31	$43,250
Total non interest bearing cash at end of year	2018-12-31	$637,921
Total non interest bearing cash at beginning of year	2018-12-31	$27,768
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$191,125
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,295,636
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,104,511
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$16,368,839
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$13,961,875
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$13,961,875
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$48,333
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$142,772,869
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$142,204,646
Employer contributions (assets) at end of year	2018-12-31	$7,357,523
Employer contributions (assets) at beginning of year	2018-12-31	$7,179,330
Contract administrator fees	2018-12-31	$1,931,331
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$11,469,464
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$9,917,204
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2018-12-31	952036255
2017 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$6,584,878
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$6,330,421
Total income from all sources (including contributions)	2017-12-31	$137,989,749
Total of all expenses incurred	2017-12-31	$138,182,385
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$135,904,043
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$137,960,107
Value of total assets at end of year	2017-12-31	$14,850,031
Value of total assets at beginning of year	2017-12-31	$14,788,210
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,278,342
Total interest from all sources	2017-12-31	$29,642
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$259,410
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$3,058,674
Participant contributions at end of year	2017-12-31	$246,452
Participant contributions at beginning of year	2017-12-31	$263,352
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$860
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$6,322,183
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$5,921,167
Administrative expenses (other) incurred	2017-12-31	$174,573
Liabilities. Value of operating payables at end of year	2017-12-31	$43,250
Liabilities. Value of operating payables at beginning of year	2017-12-31	$1,855
Total non interest bearing cash at end of year	2017-12-31	$27,768
Total non interest bearing cash at beginning of year	2017-12-31	$90,447
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-192,636
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$8,265,153
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$8,457,789
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$13,961,875
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$14,146,866
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$14,146,866
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$29,642
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$135,904,043
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$134,900,573
Employer contributions (assets) at end of year	2017-12-31	$613,936
Employer contributions (assets) at beginning of year	2017-12-31	$287,545
Contract administrator fees	2017-12-31	$1,844,359
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$219,445
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$407,399
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2017-12-31	952036255
2016 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$6,330,421
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$7,302,289
Total income from all sources (including contributions)	2016-12-31	$131,327,128
Total of all expenses incurred	2016-12-31	$131,154,457
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$128,855,623
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$131,294,300
Value of total assets at end of year	2016-12-31	$14,788,210
Value of total assets at beginning of year	2016-12-31	$15,587,407
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,298,834
Total interest from all sources	2016-12-31	$32,828
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$280,946
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$3,000,525
Participant contributions at end of year	2016-12-31	$263,352
Participant contributions at beginning of year	2016-12-31	$215,629
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$609
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$5,921,167
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$6,649,344
Administrative expenses (other) incurred	2016-12-31	$185,346
Liabilities. Value of operating payables at end of year	2016-12-31	$1,855
Liabilities. Value of operating payables at beginning of year	2016-12-31	$33,210
Total non interest bearing cash at end of year	2016-12-31	$90,447
Total non interest bearing cash at beginning of year	2016-12-31	$23,124
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$172,671
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$8,457,789
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$8,285,118
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$14,146,866
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$15,252,587
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$15,252,587
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$32,828
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$128,855,623
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$128,293,166
Employer contributions (assets) at end of year	2016-12-31	$287,545
Employer contributions (assets) at beginning of year	2016-12-31	$96,067
Contract administrator fees	2016-12-31	$1,832,542
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$407,399
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$619,735
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2016-12-31	952036255
2015 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$7,302,289
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$7,004,023
Total income from all sources (including contributions)	2015-12-31	$128,493,044
Total of all expenses incurred	2015-12-31	$125,992,432
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$123,800,182
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$128,470,668
Value of total assets at end of year	2015-12-31	$15,587,407
Value of total assets at beginning of year	2015-12-31	$12,788,529
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,192,250
Total interest from all sources	2015-12-31	$22,376
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$246,587
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$2,449,235
Participant contributions at end of year	2015-12-31	$215,629
Participant contributions at beginning of year	2015-12-31	$199,350
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$2,971
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$6,649,344
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$5,961,830
Administrative expenses (other) incurred	2015-12-31	$149,178
Liabilities. Value of operating payables at end of year	2015-12-31	$33,210
Liabilities. Value of operating payables at beginning of year	2015-12-31	$24,093
Total non interest bearing cash at end of year	2015-12-31	$23,124
Total non interest bearing cash at beginning of year	2015-12-31	$610,446
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$2,500,612
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$8,285,118
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$5,784,506
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$15,252,587
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$11,799,910
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$11,799,910
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$22,376
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$123,800,182
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$126,018,462
Employer contributions (assets) at end of year	2015-12-31	$96,067
Employer contributions (assets) at beginning of year	2015-12-31	$178,823
Contract administrator fees	2015-12-31	$1,796,485
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$619,735
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$1,018,100
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2015-12-31	952036255
2014 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$7,004,023
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$9,128,737
Total income from all sources (including contributions)	2014-12-31	$153,553,054
Total of all expenses incurred	2014-12-31	$153,733,652
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$151,645,301
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$153,521,701
Value of total assets at end of year	2014-12-31	$12,788,529
Value of total assets at beginning of year	2014-12-31	$15,093,841
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,088,351
Total interest from all sources	2014-12-31	$31,353
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$268,810
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$2,399,837
Participant contributions at end of year	2014-12-31	$199,350
Participant contributions at beginning of year	2014-12-31	$342,241
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$2,450
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$5,961,830
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$7,884,030
Administrative expenses (other) incurred	2014-12-31	$201,044
Liabilities. Value of operating payables at end of year	2014-12-31	$24,093
Liabilities. Value of operating payables at beginning of year	2014-12-31	$25,892
Total non interest bearing cash at end of year	2014-12-31	$610,446
Total non interest bearing cash at beginning of year	2014-12-31	$629,202
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-180,598
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$5,784,506
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$5,965,104
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$11,799,910
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$13,258,178
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$13,258,178
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$31,353
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$151,645,301
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$151,119,414
Employer contributions (assets) at end of year	2014-12-31	$178,823
Employer contributions (assets) at beginning of year	2014-12-31	$864,220
Contract administrator fees	2014-12-31	$1,618,497
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$1,018,100
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$1,218,815
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2014-12-31	952036255
2013 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$9,128,737
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$7,811,392
Total income from all sources (including contributions)	2013-12-31	$143,612,798
Total of all expenses incurred	2013-12-31	$143,603,156
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$141,678,454
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$143,591,540
Value of total assets at end of year	2013-12-31	$15,093,841
Value of total assets at beginning of year	2013-12-31	$13,766,854
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,924,702
Total interest from all sources	2013-12-31	$21,258
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$269,380
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$2,549,653
Participant contributions at end of year	2013-12-31	$342,241
Participant contributions at beginning of year	2013-12-31	$216,708
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$5,030
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$7,884,030
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$7,299,000
Administrative expenses (other) incurred	2013-12-31	$167,163
Liabilities. Value of operating payables at end of year	2013-12-31	$25,892
Liabilities. Value of operating payables at beginning of year	2013-12-31	$15,963
Total non interest bearing cash at end of year	2013-12-31	$629,202
Total non interest bearing cash at beginning of year	2013-12-31	$563,903
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$9,642
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$5,965,104
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$5,955,462
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$13,258,178
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$12,344,333
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$12,344,333
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$21,258
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$141,489,815
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$141,036,857
Employer contributions (assets) at end of year	2013-12-31	$864,220
Employer contributions (assets) at beginning of year	2013-12-31	$641,910
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$188,639
Contract administrator fees	2013-12-31	$1,488,159
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$1,218,815
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$496,429
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2013-12-31	952036255
2012 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$7,811,392
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$6,246,261
Total income from all sources (including contributions)	2012-12-31	$134,785,791
Total of all expenses incurred	2012-12-31	$133,725,036
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$131,768,021
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$134,761,003
Value of total assets at end of year	2012-12-31	$13,766,854
Value of total assets at beginning of year	2012-12-31	$11,140,968
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,957,015
Total interest from all sources	2012-12-31	$24,788
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$232,017
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$2,681,158
Participant contributions at end of year	2012-12-31	$216,708
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$4,113
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$15,964
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$7,299,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$5,480,426
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$143,513
Liabilities. Value of operating payables at end of year	2012-12-31	$15,963
Liabilities. Value of operating payables at beginning of year	2012-12-31	$29,472
Total non interest bearing cash at end of year	2012-12-31	$563,903
Total non interest bearing cash at beginning of year	2012-12-31	$818,852
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$1,060,755
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$5,955,462
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$4,894,707
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$12,344,333
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$9,010,783
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$9,010,783
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$24,788
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$131,170,651
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$132,075,732
Employer contributions (assets) at end of year	2012-12-31	$641,910
Employer contributions (assets) at beginning of year	2012-12-31	$1,295,369
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$597,370
Contract administrator fees	2012-12-31	$1,581,485
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$496,429
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$736,363
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2012-12-31	952036255
2011 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$6,246,261
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$5,926,537
Total income from all sources (including contributions)	2011-12-31	$109,819,958
Total of all expenses incurred	2011-12-31	$108,432,332
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$106,020,180
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$109,190,336
Value of total assets at end of year	2011-12-31	$11,140,968
Value of total assets at beginning of year	2011-12-31	$9,433,618
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$2,412,152
Total interest from all sources	2011-12-31	$26,645
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$345,556
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$1,035,954
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$60,704
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$114,315
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$15,964
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$256,997
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$5,480,426
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$4,741,932
Other income not declared elsewhere	2011-12-31	$602,977
Administrative expenses (other) incurred	2011-12-31	$135,801
Liabilities. Value of operating payables at end of year	2011-12-31	$29,472
Liabilities. Value of operating payables at beginning of year	2011-12-31	$23,953
Total non interest bearing cash at end of year	2011-12-31	$818,852
Total non interest bearing cash at beginning of year	2011-12-31	$277,669
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$1,387,626
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,894,707
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,507,081
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$9,010,783
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$8,720,890
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$8,720,890
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$26,645
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$105,419,480
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$108,040,067
Employer contributions (assets) at end of year	2011-12-31	$1,295,369
Employer contributions (assets) at beginning of year	2011-12-31	$117,358
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$600,700
Contract administrator fees	2011-12-31	$1,930,795
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$736,363
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$1,160,652
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2011-12-31	952036255
2010 : HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$5,926,537
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$6,337,473
Total income from all sources (including contributions)	2010-12-31	$107,629,045
Total of all expenses incurred	2010-12-31	$107,123,197
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$104,466,671
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$107,037,409
Value of total assets at end of year	2010-12-31	$9,433,618
Value of total assets at beginning of year	2010-12-31	$9,338,706
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,656,526
Total interest from all sources	2010-12-31	$27,040
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$492,926
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$693,558
Participant contributions at end of year	2010-12-31	$60,704
Participant contributions at beginning of year	2010-12-31	$22,725
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$708,769
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$256,997
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$163,029
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$4,741,932
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$5,293,638
Other income not declared elsewhere	2010-12-31	$564,596
Administrative expenses (other) incurred	2010-12-31	$115,306
Liabilities. Value of operating payables at end of year	2010-12-31	$23,953
Liabilities. Value of operating payables at beginning of year	2010-12-31	$17,339
Total non interest bearing cash at end of year	2010-12-31	$277,669
Total non interest bearing cash at beginning of year	2010-12-31	$132,526
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$505,848
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,507,081
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,001,233
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$8,720,890
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$7,944,570
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$7,944,570
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$27,040
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$104,133,534
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$105,635,082
Employer contributions (assets) at end of year	2010-12-31	$117,358
Employer contributions (assets) at beginning of year	2010-12-31	$1,052,706
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$333,137
Contract administrator fees	2010-12-31	$2,048,294
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$1,160,652
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$1,026,496
Assets. Value of buildings and other operty used in plan operation at end of year	2010-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2010-12-31	$23,150
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	MILLER, KAPLAN, ARASE & CO., LLP
Accountancy firm EIN	2010-12-31	952036255

Form 5500 Responses for HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST

2022: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2022 form 5500 responses
2022-01-01	Type of plan entity	Multi-employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2021 form 5500 responses
2021-01-01	Type of plan entity	Multi-employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2020 form 5500 responses
2020-01-01	Type of plan entity	Multi-employer plan
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2019 form 5500 responses
2019-01-01	Type of plan entity	Multi-employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2018 form 5500 responses
2018-01-01	Type of plan entity	Multi-employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: HEALTH CARE EMPLOYEES/EMPLOYER DENTAL AND MEDICAL TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	17
Insurance contract or identification number 34840 Number of Individuals Covered 198 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,022 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,436,554 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,022 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	33
Insurance contract or identification number 602753 Number of Individuals Covered 825 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $3,407 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $17,899,727 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,407 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	34
Insurance contract or identification number 603355 Number of Individuals Covered 832 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $17,827,934 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711931
Policy instance	35
Insurance contract or identification number 711931 Number of Individuals Covered 3636 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $55,409 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $498,688 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,409 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711956
Policy instance	36
Insurance contract or identification number 711956 Number of Individuals Covered 2003 Insurance policy start date 2021-11-01 Insurance policy end date 2022-10-31 Total amount of commissions paid to insurance broker USD $25,179 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $209,822 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,179 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	71422
Policy instance	37
Insurance contract or identification number 71422 Number of Individuals Covered 314 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,859 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,859 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	76614
Policy instance	38
Insurance contract or identification number 76614 Number of Individuals Covered 120 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,054 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,054 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	39
Insurance contract or identification number 604306 Number of Individuals Covered 763 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $2,075 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,954,502 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,075 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	40
Insurance contract or identification number 38654 Number of Individuals Covered 26 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $593 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $141,377 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $593 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	227354
Policy instance	41
Insurance contract or identification number 227354 Number of Individuals Covered 54 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $194 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $224,616 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $194 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	42
Insurance contract or identification number 228425 Number of Individuals Covered 20 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $62 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $95,735 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $62 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	43
Insurance contract or identification number 230360 Number of Individuals Covered 391 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $851 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,236,752 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $851 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	44
Insurance contract or identification number 602771 Number of Individuals Covered 53 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $246 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $13,076,523 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $246 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	32
Insurance contract or identification number 602165 Number of Individuals Covered 910 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $3,349 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,107,050 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,349 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	31
Insurance contract or identification number 602148 Number of Individuals Covered 410 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,250 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,291,906 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,250 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	18
Insurance contract or identification number 34925 Number of Individuals Covered 19 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $223 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $249,196 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $223 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	19
Insurance contract or identification number 35519 Number of Individuals Covered 282 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,163 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,198,005 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,163 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	21
Insurance contract or identification number 38655 Number of Individuals Covered 182 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $984 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,127,793 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $984 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	22
Insurance contract or identification number 124006 Number of Individuals Covered 14 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $30 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $37,573 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	23
Insurance contract or identification number 124008 Number of Individuals Covered 466 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,352 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,713,948 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,352 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	24
Insurance contract or identification number 124009 Number of Individuals Covered 227 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $752 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,207,429 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $752 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	25
Insurance contract or identification number 600519 Number of Individuals Covered 45 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $201 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $323,499 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $201 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	26
Insurance contract or identification number 600554 Number of Individuals Covered 137 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $489 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $888,721 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $489 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	27
Insurance contract or identification number 600575 Number of Individuals Covered 120 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $701,377 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	28
Insurance contract or identification number 600593 Number of Individuals Covered 2085 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $10,081 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $22,945,231 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,081 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	29
Insurance contract or identification number 600819 Number of Individuals Covered 730 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $2,836 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,508,086 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,836 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	30
Insurance contract or identification number 602030 Number of Individuals Covered 1173 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $3,744 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,741,361 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,744 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602772
Policy instance	45
Insurance contract or identification number 602772 Number of Individuals Covered 13 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $36 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $59,844 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	20
Insurance contract or identification number 36301 Number of Individuals Covered 12 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $13 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,057 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	5
Insurance contract or identification number 1724 Number of Individuals Covered 117 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract number	N11063457003
Policy instance	6
Insurance contract or identification number N11063457003 Number of Individuals Covered 1818 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $45,850 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $305,670 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $45,850 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	7
Insurance contract or identification number 742364 Number of Individuals Covered 864 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $7,197 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $102,882 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,197 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	8
Insurance contract or identification number 1862 Number of Individuals Covered 5897 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	1928
Policy instance	9
Insurance contract or identification number 1928 Number of Individuals Covered 3 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	2288
Policy instance	10
Insurance contract or identification number 2288 Number of Individuals Covered 432 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	2441
Policy instance	11
Insurance contract or identification number 2441 Number of Individuals Covered 184 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $2,713 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,713 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	12
Insurance contract or identification number 2596 Number of Individuals Covered 1873 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	3208
Policy instance	13
Insurance contract or identification number 3208 Number of Individuals Covered 417 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	4215
Policy instance	14
Insurance contract or identification number 4215 Number of Individuals Covered 590 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	8739
Policy instance	15
Insurance contract or identification number 8739 Number of Individuals Covered 490 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	3676
Policy instance	16
Insurance contract or identification number 3676 Number of Individuals Covered 3117 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes 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 number	1539
Policy instance	4
Insurance contract or identification number 1539 Number of Individuals Covered 257 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	3
Insurance contract or identification number GL129620 Number of Individuals Covered 870 Insurance policy start date 2021-02-01 Insurance policy end date 2022-01-31 Total amount of fees paid to insurance company USD $343 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $28,549 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 343 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker organization code? 3
SUTTER HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15107 )
Policy contract number	193802
Policy instance	46
Insurance contract or identification number 193802 Number of Individuals Covered 279 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,116,237 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	231670
Policy instance	47
Insurance contract or identification number 231670 Number of Individuals Covered 1811 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $5,230 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $23,594,134 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,230 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	48
Insurance contract or identification number 603816 Number of Individuals Covered 3627 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $15,361 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $31,337,625 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,361 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605867
Policy instance	49
Insurance contract or identification number 605867 Number of Individuals Covered 295 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,034 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,589,289 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,034 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	718697
Policy instance	50
Insurance contract or identification number 718697 Number of Individuals Covered 290 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $750,999 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	30082127
Policy instance	51
Insurance contract or identification number 30082127 Number of Individuals Covered 295 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $918 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $15,329 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $918
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0913935
Policy instance	52
Insurance contract or identification number 0913935 Number of Individuals Covered 281 Insurance policy start date 2021-03-01 Insurance policy end date 2022-02-28 Total amount of commissions paid to insurance broker USD $2,097 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $34,947 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,097 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605207
Policy instance	53
Insurance contract or identification number 605207 Number of Individuals Covered 88 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $234 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $379,568 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $234 Insurance broker organization code? 3
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	E0194/02/03/04
Policy instance	2
Insurance contract or identification number E0194/02/03/04 Number of Individuals Covered 114 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $837,156 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	34837
Policy instance	1
Insurance contract or identification number 34837 Number of Individuals Covered 57 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $291 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $478,304 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $291 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	75511
Policy instance	56
Insurance contract or identification number 75511 Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract number	W0073053
Policy instance	55
Insurance contract or identification number W0073053 Number of Individuals Covered 338 Insurance policy start date 2022-04-01 Insurance policy end date 2022-07-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $974,547 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	606721
Policy instance	54
Insurance contract or identification number 606721 Number of Individuals Covered 74 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $220 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $453,812 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $220
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3676
Policy instance	17
Insurance contract or identification number 3676 Number of Individuals Covered 3009 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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	34840
Policy instance	18
Insurance contract or identification number 34840 Number of Individuals Covered 259 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $12,769 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,228,937 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,769 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	19
Insurance contract or identification number 34925 Number of Individuals Covered 64 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,094 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $372,083 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,094 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	20
Insurance contract or identification number 35519 Number of Individuals Covered 300 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $14,516 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,478,826 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,516 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	21
Insurance contract or identification number 36301 Number of Individuals Covered 11 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $197 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $91,468 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $197
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	22
Insurance contract or identification number 38655 Number of Individuals Covered 248 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $13,243 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,125,986 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,243 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	23
Insurance contract or identification number 124006 Number of Individuals Covered 14 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $388 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $67,043 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $388 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	24
Insurance contract or identification number 124008 Number of Individuals Covered 463 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $18,413 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,177,621 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,413 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	25
Insurance contract or identification number 124009 Number of Individuals Covered 244 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $12,296 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,012,953 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,296 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	26
Insurance contract or identification number 600519 Number of Individuals Covered 51 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,031 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $348,663 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,031 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	27
Insurance contract or identification number 600554 Number of Individuals Covered 130 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,056,440 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	28
Insurance contract or identification number 600575 Number of Individuals Covered 141 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $6,665 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,135,931 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,665 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	30
Insurance contract or identification number 600819 Number of Individuals Covered 763 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $5,806 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,498,643 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,806 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	16
Insurance contract or identification number 8739 Number of Individuals Covered 510 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes 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 number	4215
Policy instance	15
Insurance contract or identification number 4215 Number of Individuals Covered 659 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	3
Insurance contract or identification number GL129620 Number of Individuals Covered 1043 Insurance policy start date 2020-02-01 Insurance policy end date 2021-01-31 Total amount of fees paid to insurance company USD $455 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,788 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 455 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker organization code? 3
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	E0194/02/03/04
Policy instance	2
Insurance contract or identification number E0194/02/03/04 Number of Individuals Covered 120 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $827,218 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	34837
Policy instance	1
Insurance contract or identification number 34837 Number of Individuals Covered 59 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $3,429 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $596,405 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,429 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	5
Insurance contract or identification number 1539 Number of Individuals Covered 253 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes 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 number	1724
Policy instance	6
Insurance contract or identification number 1724 Number of Individuals Covered 104 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	8
Insurance contract or identification number 742364 Total amount of commissions paid to insurance broker USD $25,338 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $25,338 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	9
Insurance contract or identification number 1862 Number of Individuals Covered 5889 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes 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 number	1928
Policy instance	10
Insurance contract or identification number 1928 Number of Individuals Covered 3 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes 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 number	2288
Policy instance	11
Insurance contract or identification number 2288 Number of Individuals Covered 505 Insurance policy start date 2021-01-01 Insurance policy end date 2021-03-31 Dental Insurance Welfare Benefit Yes 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 number	2441
Policy instance	12
Insurance contract or identification number 2441 Number of Individuals Covered 189 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	13
Insurance contract or identification number 2596 Number of Individuals Covered 1803 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes 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 number	3208
Policy instance	14
Insurance contract or identification number 3208 Number of Individuals Covered 457 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	4
Insurance contract or identification number VAR201237 Number of Individuals Covered 1043 Insurance policy start date 2020-02-01 Insurance policy end date 2021-01-31 Total amount of fees paid to insurance company USD $46 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $2,679 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 46 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0913935
Policy instance	53
Insurance contract or identification number 0913935 Number of Individuals Covered 4162 Insurance policy start date 2020-03-01 Insurance policy end date 2021-02-28 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,695 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	45
Insurance contract or identification number 602771 Number of Individuals Covered 68 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,740 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $452,455 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,740 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602772
Policy instance	46
Insurance contract or identification number 602772 Number of Individuals Covered 10 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $460 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $77,164 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $460 Insurance broker organization code? 3
SUTTER HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15107 )
Policy contract number	193802
Policy instance	47
Insurance contract or identification number 193802 Number of Individuals Covered 277 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,005,160 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	231670
Policy instance	48
Insurance contract or identification number 231670 Number of Individuals Covered 1617 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $48,542 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,939,762 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $48,542 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	49
Insurance contract or identification number 603816 Number of Individuals Covered 3666 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $189,037 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $32,588,685 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $189,037 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605867
Policy instance	50
Insurance contract or identification number 605867 Number of Individuals Covered 279 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $13,053 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,231,486 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,053 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	718697
Policy instance	51
Insurance contract or identification number 718697 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	30082127
Policy instance	52
Insurance contract or identification number 30082127 Number of Individuals Covered 276 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $886 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,756 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $886
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	7
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1806 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $21,339 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $284,517 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,339 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	75511
Policy instance	56
Insurance contract or identification number 75511 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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	606721
Policy instance	55
Insurance contract or identification number 606721 Number of Individuals Covered 51 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,489 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $475,849 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,489 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605207
Policy instance	54
Insurance contract or identification number 605207 Number of Individuals Covered 88 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,612 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $454,378 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,612 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	44
Insurance contract or identification number 230360 Number of Individuals Covered 373 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $11,508 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,972,743 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,508 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	43
Insurance contract or identification number 228425 Number of Individuals Covered 20 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $845 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $148,209 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $845 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	29
Insurance contract or identification number 600593 Number of Individuals Covered 1992 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $128,758 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $21,826,896 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $128,758 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	31
Insurance contract or identification number 602030 Number of Individuals Covered 1201 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $36,489 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,224,518 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36,489 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	32
Insurance contract or identification number 602148 Number of Individuals Covered 374 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $14,907 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,588,195 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,907 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	33
Insurance contract or identification number 602165 Number of Individuals Covered 951 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $38,648 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,625,385 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $38,648 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	34
Insurance contract or identification number 602753 Number of Individuals Covered 771 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $39,938 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,947,351 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,938 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	35
Insurance contract or identification number 603355 Number of Individuals Covered 898 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $32,824 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,621,507 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,824 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711931
Policy instance	36
Insurance contract or identification number 711931 Number of Individuals Covered 3646 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $56,736 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $439,450 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,736 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	227354
Policy instance	42
Insurance contract or identification number 227354 Number of Individuals Covered 64 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,616 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $486,790 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,616 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	41
Insurance contract or identification number 38654 Number of Individuals Covered 28 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $1,270 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $220,893 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,270 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	40
Insurance contract or identification number 604306 Number of Individuals Covered 788 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $19,929 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,421,601 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,929 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	76614
Policy instance	39
Insurance contract or identification number 76614 Number of Individuals Covered 126 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	71422
Policy instance	38
Insurance contract or identification number 71422 Number of Individuals Covered 354 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711956
Policy instance	37
Insurance contract or identification number 711956 Number of Individuals Covered 1964 Insurance policy start date 2020-11-01 Insurance policy end date 2021-10-31 Total amount of commissions paid to insurance broker USD $25,338 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $211,154 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,338 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	227354
Policy instance	42
Insurance contract or identification number 227354 Number of Individuals Covered 44 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,451 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $339,892 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,451 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	41
Insurance contract or identification number 38654 Number of Individuals Covered 28 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $995 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $228,351 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $995 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	40
Insurance contract or identification number 604306 Number of Individuals Covered 1022 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $19,655 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,545,642 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,655 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	76614
Policy instance	39
Insurance contract or identification number 76614 Number of Individuals Covered 154 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,282 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $42,749 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,282 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	71422
Policy instance	38
Insurance contract or identification number 71422 Number of Individuals Covered 334 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,934 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $69,986 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,934 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711956
Policy instance	37
Insurance contract or identification number 711956 Number of Individuals Covered 2070 Insurance policy start date 2019-11-01 Insurance policy end date 2020-10-31 Total amount of commissions paid to insurance broker USD $26,348 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $200,471 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,348 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711931
Policy instance	36
Insurance contract or identification number 711931 Number of Individuals Covered 3238 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $44,139 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $401,585 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $44,139 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	33
Insurance contract or identification number 602165 Number of Individuals Covered 1065 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $33,456 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,508,478 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $33,456 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	35
Insurance contract or identification number 603355 Number of Individuals Covered 858 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $25,553 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,051,621 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,553 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	34
Insurance contract or identification number 602753 Number of Individuals Covered 632 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $28,666 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,775,485 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $28,666 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	43
Insurance contract or identification number 228425 Number of Individuals Covered 20 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $628 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $148,306 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $628 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	44
Insurance contract or identification number 230360 Number of Individuals Covered 412 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $9,640 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,235,355 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,640 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	45
Insurance contract or identification number 602771 Number of Individuals Covered 72 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $2,203 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $528,971 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,203 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	19
Insurance contract or identification number 34925 Number of Individuals Covered 34 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,305 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $311,978 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,305 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605207
Policy instance	54
Insurance contract or identification number 605207 Number of Individuals Covered 62 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,865 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $442,749 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,865 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0913935
Policy instance	53
Insurance contract or identification number 0913935 Number of Individuals Covered 239 Insurance policy start date 2019-03-01 Insurance policy end date 2020-02-29 Total amount of commissions paid to insurance broker USD $1,585 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $28,690 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,585 Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	30082127
Policy instance	52
Insurance contract or identification number 30082127 Number of Individuals Covered 261 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $877 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,642 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $877
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	718697
Policy instance	51
Insurance contract or identification number 718697 Number of Individuals Covered 271 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,928,157 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	605867
Policy instance	50
Insurance contract or identification number 605867 Number of Individuals Covered 261 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $9,802 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,337,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,802 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	49
Insurance contract or identification number 603816 Number of Individuals Covered 3242 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $149,625 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $35,115,639 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $149,625 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231670
Policy instance	48
Insurance contract or identification number 231670 Number of Individuals Covered 654 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $18,186 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,344,532 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,186 Insurance broker organization code? 3
SUTTER HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15107 )
Policy contract number	193802
Policy instance	47
Insurance contract or identification number 193802 Number of Individuals Covered 243 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,814,593 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	602772
Policy instance	46
Insurance contract or identification number 602772 Number of Individuals Covered 11 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $445 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $103,913 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $445 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	32
Insurance contract or identification number 602148 Number of Individuals Covered 310 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $13,012 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,991,506 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,012 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	31
Insurance contract or identification number 602030 Number of Individuals Covered 1177 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $30,104 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,158,162 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30,104 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	30
Insurance contract or identification number 600819 Number of Individuals Covered 949 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $156 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,949,677 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $156 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	4215
Policy instance	15
Insurance contract or identification number 4215 Number of Individuals Covered 651 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes 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 number	3208
Policy instance	14
Insurance contract or identification number 3208 Number of Individuals Covered 476 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes 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 number	2596
Policy instance	13
Insurance contract or identification number 2596 Number of Individuals Covered 1861 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes 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 number	2441
Policy instance	12
Insurance contract or identification number 2441 Number of Individuals Covered 200 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $3,061 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,061 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	11
Insurance contract or identification number 2288 Number of Individuals Covered 419 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes 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 number	1928
Policy instance	10
Insurance contract or identification number 1928 Number of Individuals Covered 3 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	8
Insurance contract or identification number 742364 Number of Individuals Covered 881 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $6,187 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $88,381 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,187 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	7
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1762 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $21,346 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $284,617 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,346 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	6
Insurance contract or identification number 1724 Number of Individuals Covered 96 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes 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 number	1539
Policy instance	5
Insurance contract or identification number 1539 Number of Individuals Covered 239 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	4
Insurance contract or identification number VAR201237 Number of Individuals Covered 1108 Insurance policy start date 2019-02-01 Insurance policy end date 2020-01-31 Total amount of commissions paid to insurance broker USD $337 Total amount of fees paid to insurance company USD $42 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $3,368 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $337 Insurance broker organization code? 3 Amount paid for insurance broker fees 42 Additional information about fees paid to insurance broker ADMINISTRATIVE
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	3
Insurance contract or identification number GL129620 Number of Individuals Covered 1108 Insurance policy start date 2019-02-01 Insurance policy end date 2020-01-31 Total amount of commissions paid to insurance broker USD $3,368 Total amount of fees paid to insurance company USD $458 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $33,685 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,368 Insurance broker organization code? 3 Amount paid for insurance broker fees 458 Additional information about fees paid to insurance broker ADMINISTRATIVE
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	16
Insurance contract or identification number 8739 Number of Individuals Covered 583 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes 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 number	3676
Policy instance	17
Insurance contract or identification number 3676 Number of Individuals Covered 2961 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 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	600593
Policy instance	29
Insurance contract or identification number 600593 Number of Individuals Covered 2008 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $113,356 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,573,192 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $113,356 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	28
Insurance contract or identification number 600575 Number of Individuals Covered 137 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $6,162 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,421,481 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,162 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	27
Insurance contract or identification number 600554 Number of Individuals Covered 117 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $4,919 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,148,891 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,919 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	26
Insurance contract or identification number 600519 Number of Individuals Covered 27 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,718 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $404,596 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,718 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	25
Insurance contract or identification number 124009 Number of Individuals Covered 396 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $13,094 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,060,531 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,094 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	24
Insurance contract or identification number 124008 Number of Individuals Covered 481 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $14,397 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,403,477 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,397 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	23
Insurance contract or identification number 124006 Number of Individuals Covered 15 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $305 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,006 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $305 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	22
Insurance contract or identification number 38655 Number of Individuals Covered 251 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $11,598 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,483,292 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,598 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	21
Insurance contract or identification number 36301 Number of Individuals Covered 12 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $154 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $120,028 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $154
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	20
Insurance contract or identification number 35519 Number of Individuals Covered 283 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $10,599 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,536,675 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,599 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	9
Insurance contract or identification number 1862 Number of Individuals Covered 6257 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 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	34840
Policy instance	18
Insurance contract or identification number 34840 Number of Individuals Covered 224 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $9,438 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,203,630 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,438 Insurance broker organization code? 3
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	E0194/02/03/04
Policy instance	2
Insurance contract or identification number E0194/02/03/04 Number of Individuals Covered 115 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $754,930 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	34837
Policy instance	1
Insurance contract or identification number 34837 Number of Individuals Covered 46 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $2,327 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $551,476 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,327 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34837
Policy instance	53
Insurance contract or identification number 34837 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	7
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1762 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $25,762 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $343,499 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,762 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231670
Policy instance	49
Insurance contract or identification number 231670 Number of Individuals Covered 578 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $21,259 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,898,330 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,259 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602772
Policy instance	47
Insurance contract or identification number 602772 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 $434 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $79,469 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $434 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	76614
Policy instance	40
Insurance contract or identification number 76614 Number of Individuals Covered 141 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,210 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $40,329 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,210 Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	30082127
Policy instance	55
Insurance contract or identification number 30082127 Number of Individuals Covered 240 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $900 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,885 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $900
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34837
Policy instance	1
Insurance contract or identification number 34837 Number of Individuals Covered 46 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $2,214 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $408,807 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $2,214 Additional information about fees paid to insurance broker FEE Insurance broker organization code? 3
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	S4511/6/8
Policy instance	2
Insurance contract or identification number S4511/6/8 Number of Individuals Covered 127 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $806,689 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	3
Insurance contract or identification number GL129620 Number of Individuals Covered 1273 Insurance policy start date 2018-02-01 Insurance policy end date 2019-01-31 Total amount of commissions paid to insurance broker USD $3,649 Total amount of fees paid to insurance company USD $375 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $36,493 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,649 Insurance broker organization code? 3 Amount paid for insurance broker fees 375 Additional information about fees paid to insurance broker ADMINISTRATIVE
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	4
Insurance contract or identification number VAR201237 Number of Individuals Covered 1273 Insurance policy start date 2018-02-01 Insurance policy end date 2019-01-31 Total amount of commissions paid to insurance broker USD $365 Total amount of fees paid to insurance company USD $41 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $3,649 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $365 Insurance broker organization code? 3 Amount paid for insurance broker fees 41 Additional information about fees paid to insurance broker ADMINISTRATIVE
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	5
Insurance contract or identification number 1539 Number of Individuals Covered 232 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	1724
Policy instance	6
Insurance contract or identification number 1724 Number of Individuals Covered 117 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	8
Insurance contract or identification number 742364 Number of Individuals Covered 780 Insurance policy start date 2018-06-01 Insurance policy end date 2019-05-31 Total amount of commissions paid to insurance broker USD $5,801 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $82,865 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,801 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603178
Policy instance	53
Insurance contract or identification number 603178 Number of Individuals Covered 0 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231427
Policy instance	54
Insurance contract or identification number 231427 Number of Individuals Covered 0 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Welfare Benefit Premiums Paid to Carrier USD $0 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	603178
Policy instance	54
Insurance contract or identification number 603178 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231427
Policy instance	55
Insurance contract or identification number 231427 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	30082127
Policy instance	56
Insurance contract or identification number 30082127 Number of Individuals Covered 240 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $900 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,885 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $900
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	718697
Policy instance	52
Insurance contract or identification number 718697 Number of Individuals Covered 186 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,465,263 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605867
Policy instance	51
Insurance contract or identification number 605867 Number of Individuals Covered 234 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $9,829 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,815,909 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,829 Insurance broker organization code? 3
SUTTER HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15107 )
Policy contract number	193802
Policy instance	48
Insurance contract or identification number 193802 Number of Individuals Covered 243 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,664,409 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	603816
Policy instance	50
Insurance contract or identification number 603816 Number of Individuals Covered 3411 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $160,621 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $29,538,752 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $160,621 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	46
Insurance contract or identification number 602771 Number of Individuals Covered 45 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,800 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $332,623 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,800 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	45
Insurance contract or identification number 230360 Number of Individuals Covered 315 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $6,613 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,247,076 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,613 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	44
Insurance contract or identification number 228425 Number of Individuals Covered 22 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $725 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $134,704 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $725 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	227354
Policy instance	43
Insurance contract or identification number 227354 Number of Individuals Covered 48 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,435 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $265,332 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,435 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	42
Insurance contract or identification number 38654 Number of Individuals Covered 29 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,204 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $214,805 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,204 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	27
Insurance contract or identification number 600554 Number of Individuals Covered 132 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,693 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,040,976 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,693 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	9
Insurance contract or identification number 1862 Number of Individuals Covered 7042 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	1928
Policy instance	10
Insurance contract or identification number 1928 Number of Individuals Covered 3 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 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	124009
Policy instance	25
Insurance contract or identification number 124009 Number of Individuals Covered 416 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $13,388 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,492,443 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,388 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711956
Policy instance	37
Insurance contract or identification number 711956 Number of Individuals Covered 2178 Insurance policy start date 2018-11-01 Insurance policy end date 2019-10-31 Total amount of commissions paid to insurance broker USD $27,474 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $248,174 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $27,474 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711931
Policy instance	36
Insurance contract or identification number 711931 Number of Individuals Covered 3448 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $52,567 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $438,013 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $52,567 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	34
Insurance contract or identification number 602753 Number of Individuals Covered 624 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $28,532 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,237,698 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $28,532 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	33
Insurance contract or identification number 602165 Number of Individuals Covered 1146 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $36,003 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,674,663 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36,003 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	23
Insurance contract or identification number 124006 Number of Individuals Covered 15 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $320 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $58,679 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $320 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	22
Insurance contract or identification number 38655 Number of Individuals Covered 281 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $13,014 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,418,639 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,014 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	32
Insurance contract or identification number 602148 Number of Individuals Covered 406 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $14,449 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $14,449 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	31
Insurance contract or identification number 602030 Number of Individuals Covered 1090 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $27,020 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,147,660 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,020 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	30
Insurance contract or identification number 600819 Number of Individuals Covered 948 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $166 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,118,192 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $166 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	29
Insurance contract or identification number 600593 Number of Individuals Covered 2134 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $116,657 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $21,528,696 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $116,657 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	28
Insurance contract or identification number 600575 Number of Individuals Covered 170 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $7,377 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,384,854 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,377 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	35
Insurance contract or identification number 603355 Number of Individuals Covered 822 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $24,767 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,567,869 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,767 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	26
Insurance contract or identification number 600519 Number of Individuals Covered 57 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $2,505 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $453,463 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,505 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	24
Insurance contract or identification number 124008 Number of Individuals Covered 474 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $14,751 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,729,548 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,751 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	41
Insurance contract or identification number 604306 Number of Individuals Covered 921 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $22,571 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,361,737 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,571 Insurance broker organization code? 3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11634
Policy instance	38
Insurance contract or identification number 11634 Number of Individuals Covered 82 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $25,720 Total amount of fees paid to insurance company USD $15,772 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $259,001 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $9,002 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3 Amount paid for insurance broker fees 15772
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	71422
Policy instance	39
Insurance contract or identification number 71422 Number of Individuals Covered 360 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $2,069 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,790 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,069 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	11
Insurance contract or identification number 2288 Number of Individuals Covered 391 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	2441
Policy instance	12
Insurance contract or identification number 2441 Number of Individuals Covered 198 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $3,056 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,056 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	13
Insurance contract or identification number 2596 Number of Individuals Covered 1759 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	3208
Policy instance	14
Insurance contract or identification number 3208 Number of Individuals Covered 481 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	4215
Policy instance	15
Insurance contract or identification number 4215 Number of Individuals Covered 680 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	8739
Policy instance	16
Insurance contract or identification number 8739 Number of Individuals Covered 550 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes 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 number	3676
Policy instance	17
Insurance contract or identification number 3676 Number of Individuals Covered 3301 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 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	34840
Policy instance	18
Insurance contract or identification number 34840 Number of Individuals Covered 219 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $10,876 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,931,493 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,876 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	19
Insurance contract or identification number 34925 Number of Individuals Covered 32 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,336 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $242,498 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,336 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	20
Insurance contract or identification number 35519 Number of Individuals Covered 244 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $11,513 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,114,180 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,513 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	21
Insurance contract or identification number 36301 Number of Individuals Covered 19 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $182 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $145,010 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $182
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	49
Insurance contract or identification number 34840 Number of Individuals Covered 410 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $14,635 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,976,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,635 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1928
Policy instance	40
Insurance contract or identification number 1928 Number of Individuals Covered 5 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 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	124009
Policy instance	43
Insurance contract or identification number 124009 Number of Individuals Covered 392 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $11,274 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,277,925 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,274 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602772
Policy instance	38
Insurance contract or identification number 602772 Number of Individuals Covered 11 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $444 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $88,871 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $444 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	76614
Policy instance	37
Insurance contract or identification number 76614 Number of Individuals Covered 141 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,093 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $36,425 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,093 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	36
Insurance contract or identification number 604306 Number of Individuals Covered 294 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $8,567 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,728,591 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,567 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	35
Insurance contract or identification number 600593 Number of Individuals Covered 2080 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $104,668 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $21,114,102 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $104,668 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711956
Policy instance	41
Insurance contract or identification number 711956 Number of Individuals Covered 2108 Insurance policy start date 2017-11-01 Insurance policy end date 2018-10-31 Total amount of commissions paid to insurance broker USD $26,029 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $216,909 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,029 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	42
Insurance contract or identification number 602753 Number of Individuals Covered 624 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $29,263 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,821,353 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,263 Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	48
Insurance contract or identification number VAR201237 Number of Individuals Covered 800 Insurance policy start date 2017-02-01 Insurance policy end date 2018-01-31 Total amount of commissions paid to insurance broker USD $310 Total amount of fees paid to insurance company USD $34 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $3,097 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $310 Insurance broker organization code? 3 Amount paid for insurance broker fees 34 Additional information about fees paid to insurance broker ADMINISTRATIVE
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	50
Insurance contract or identification number 124006 Number of Individuals Covered 15 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $260 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $53,971 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $260 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3676
Policy instance	51
Insurance contract or identification number 3676 Number of Individuals Covered 3229 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 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	605867
Policy instance	13
Insurance contract or identification number 605867 Number of Individuals Covered 235 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $6,100 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,372,596 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,100 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	52
Insurance contract or identification number 8739 Number of Individuals Covered 559 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 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	231670
Policy instance	47
Insurance contract or identification number 231670 Number of Individuals Covered 658 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $21,231 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,283,331 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,231 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	44
Insurance contract or identification number 742364 Number of Individuals Covered 753 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $5,578 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $79,683 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,578 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34837
Policy instance	45
Insurance contract or identification number 34837 Number of Individuals Covered 39 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,101 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $422,306 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,101 Additional information about fees paid to insurance broker FEE Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	46
Insurance contract or identification number 38655 Number of Individuals Covered 554 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $23,873 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,753,258 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,873 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	71422
Policy instance	34
Insurance contract or identification number 71422 Number of Individuals Covered 322 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,885 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $63,291 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,885 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	33
Insurance contract or identification number 600575 Number of Individuals Covered 150 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $5,332 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,047,169 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,332 Insurance broker organization code? 3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11634
Policy instance	15
Insurance contract or identification number 11634 Number of Individuals Covered 88 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $28,151 Total amount of fees paid to insurance company USD $17,204 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $281,651 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,853 Insurance broker organization code? 3 Amount paid for insurance broker fees 17204 Additional information about fees paid to insurance broker SELECT BENEFITS VOLUME BONUS
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	12
Insurance contract or identification number 228425 Number of Individuals Covered 21 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $635 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $126,985 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $635 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	2
Insurance contract or identification number 603355 Number of Individuals Covered 789 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $22,147 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,463,092 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,147 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	711931
Policy instance	11
Insurance contract or identification number 711931 Number of Individuals Covered 3654 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $53,421 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $445,176 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $53,421 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	10
Insurance contract or identification number 230360 Number of Individuals Covered 277 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $6,289 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,242,993 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,289 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	9
Insurance contract or identification number 603816 Number of Individuals Covered 3625 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $152,807 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $30,740,873 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $152,807 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	8
Insurance contract or identification number 600554 Number of Individuals Covered 151 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $6,211 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,241,973 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,211 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	7
Insurance contract or identification number 600819 Number of Individuals Covered 1063 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $161 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,029,296 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $161 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2441
Policy instance	6
Insurance contract or identification number 2441 Number of Individuals Covered 200 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $3,329 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,329 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	5
Insurance contract or identification number 2596 Number of Individuals Covered 1572 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Dental Insurance Welfare Benefit Yes 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 number	1862
Policy instance	4
Insurance contract or identification number 1862 Number of Individuals Covered 6616 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 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	602165
Policy instance	3
Insurance contract or identification number 602165 Number of Individuals Covered 1213 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $36,802 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,674,778 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36,802 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	19
Insurance contract or identification number GL129620 Number of Individuals Covered 807 Insurance policy start date 2017-02-01 Insurance policy end date 2018-01-31 Total amount of commissions paid to insurance broker USD $3,114 Total amount of fees paid to insurance company USD $340 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $31,009 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,114 Insurance broker organization code? 3 Amount paid for insurance broker fees 340 Additional information about fees paid to insurance broker ADMINISTRATIVE
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	1
Insurance contract or identification number 36301 Number of Individuals Covered 21 Insurance policy start date 2018-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $180 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $369,418 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $180
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	39
Insurance contract or identification number 602771 Number of Individuals Covered 43 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,837 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $362,038 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,837 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	14
Insurance contract or identification number 124008 Number of Individuals Covered 470 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $13,402 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,701,054 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,402 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	16
Insurance contract or identification number 1539 Number of Individuals Covered 232 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 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	38654
Policy instance	32
Insurance contract or identification number 38654 Number of Individuals Covered 34 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,175 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $242,176 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,175 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	31
Insurance contract or identification number 600519 Number of Individuals Covered 59 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,596 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $462,735 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,596 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	30
Insurance contract or identification number 602030 Number of Individuals Covered 827 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $22,721 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,702,317 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,721 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	4215
Policy instance	29
Insurance contract or identification number 4215 Number of Individuals Covered 700 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Dental Insurance Welfare Benefit Yes 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 number	MG-103 18398
Policy instance	27
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1718 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $25,780 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $343,738 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,780 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	26
Insurance contract or identification number 34925 Number of Individuals Covered 37 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,590 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $312,801 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,590 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	718697
Policy instance	25
Insurance contract or identification number 718697 Number of Individuals Covered 205 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,200,619 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	227354
Policy instance	24
Insurance contract or identification number 227354 Number of Individuals Covered 45 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,494 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $296,151 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,494 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	23
Insurance contract or identification number 1724 Number of Individuals Covered 121 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Dental Insurance Welfare Benefit Yes 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 number	3208
Policy instance	22
Insurance contract or identification number 3208 Number of Individuals Covered 475 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUTTER HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15107 )
Policy contract number	193802
Policy instance	21
Insurance contract or identification number 193802 Number of Individuals Covered 237 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,279,863 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	35519
Policy instance	20
Insurance contract or identification number 35519 Number of Individuals Covered 268 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $11,440 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,289,160 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,440 Insurance broker organization code? 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	18
Insurance contract or identification number 2288 Number of Individuals Covered 393 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 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	602148
Policy instance	17
Insurance contract or identification number 602148 Number of Individuals Covered 376 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $14,491 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,880,955 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,491 Insurance broker organization code? 3
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	S4511/6/8
Policy instance	28
Insurance contract or identification number S4511/6/8 Number of Individuals Covered 121 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $724,900 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	S04510
Policy instance	38
Insurance contract or identification number S04510 Number of Individuals Covered 113 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $813,131 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11634
Policy instance	51
Insurance contract or identification number 11634 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 $27,894 Total amount of fees paid to insurance company USD $16,421 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $278,940 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,763 Insurance broker organization code? 3 Amount paid for insurance broker fees 16421 Additional information about fees paid to insurance broker SELECT BENEFITS VOLUME BONUS Insurance broker name MGU OF THE WEST INS SVCS INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	37
Insurance contract or identification number 602165 Number of Individuals Covered 1342 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $38,006 Total amount of fees paid to insurance company USD $6 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,103,941 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $38,006 Amount paid for insurance broker fees 6 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231670
Policy instance	36
Insurance contract or identification number 231670 Number of Individuals Covered 692 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $21,969 Total amount of fees paid to insurance company USD $3 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,020,969 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,969 Amount paid for insurance broker fees 3 Additional information about fees paid to insurance broker FEE Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2441
Policy instance	35
Insurance contract or identification number 2441 Number of Individuals Covered 222 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $3,380 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,380 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	34
Insurance contract or identification number 1539 Number of Individuals Covered 541 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	33
Insurance contract or identification number GL129620 Number of Individuals Covered 1095 Insurance policy start date 2016-02-01 Insurance policy end date 2017-01-31 Total amount of commissions paid to insurance broker USD $2,961 Total amount of fees paid to insurance company USD $1,131 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $29,611 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,961 Insurance broker organization code? 3 Amount paid for insurance broker fees 1131 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker name NFP INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	32
Insurance contract or identification number 603355 Number of Individuals Covered 756 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $20,597 Total amount of fees paid to insurance company USD $3 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,144,622 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,597 Amount paid for insurance broker fees 3 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	30
Insurance contract or identification number 38654 Number of Individuals Covered 33 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,349 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $258,675 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,349 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34837
Policy instance	29
Insurance contract or identification number 34837 Number of Individuals Covered 40 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,843 Total amount of fees paid to insurance company USD $307 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $379,678 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,843 Amount paid for insurance broker fees 307 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	28
Insurance contract or identification number 34840 Number of Individuals Covered 330 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $12,913 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,589,809 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,913 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	27
Insurance contract or identification number 38655 Number of Individuals Covered 564 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $23,608 Total amount of fees paid to insurance company USD $3 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,713,921 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,608 Amount paid for insurance broker fees 3 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	39
Insurance contract or identification number 2288 Number of Individuals Covered 904 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Dental Insurance Welfare Benefit Yes 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 number	8739
Policy instance	40
Insurance contract or identification number 8739 Number of Individuals Covered 1149 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 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	603816
Policy instance	50
Insurance contract or identification number 603816 Number of Individuals Covered 3539 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $146,510 Total amount of fees paid to insurance company USD $16 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $29,297,632 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $146,510 Amount paid for insurance broker fees 16 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCES SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	49
Insurance contract or identification number 1724 Number of Individuals Covered 128 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 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	602030
Policy instance	48
Insurance contract or identification number 602030 Number of Individuals Covered 718 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $20,706 Total amount of fees paid to insurance company USD $3 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,143,804 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,706 Amount paid for insurance broker fees 3 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711931
Policy instance	47
Insurance contract or identification number 0711931 Number of Individuals Covered 3541 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $64,432 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $493,787 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $64,432 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	71422
Policy instance	46
Insurance contract or identification number 71422 Number of Individuals Covered 535 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $2,263 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $75,556 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,263 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	45
Insurance contract or identification number 742364 Number of Individuals Covered 738 Insurance policy start date 2016-06-01 Insurance policy end date 2017-05-31 Total amount of commissions paid to insurance broker USD $6,915 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $98,790 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,915 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3676
Policy instance	44
Insurance contract or identification number 3676 Number of Individuals Covered 8973 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 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	124009
Policy instance	43
Insurance contract or identification number 124009 Number of Individuals Covered 366 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $10,246 Total amount of fees paid to insurance company USD $2 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,058,429 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,246 Amount paid for insurance broker fees 2 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	42
Insurance contract or identification number VAR201237 Number of Individuals Covered 1095 Insurance policy start date 2016-02-01 Insurance policy end date 2017-01-31 Total amount of commissions paid to insurance broker USD $296 Total amount of fees paid to insurance company USD $113 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $2,961 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $296 Insurance broker organization code? 3 Amount paid for insurance broker fees 113 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker name NFP INSURANCE SERVICES INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	76614
Policy instance	41
Insurance contract or identification number 76614 Number of Individuals Covered 240 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,322 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $44,075 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,322 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	26
Insurance contract or identification number 602753 Number of Individuals Covered 688 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $30,346 Total amount of fees paid to insurance company USD $3 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,061,560 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30,346 Amount paid for insurance broker fees 3 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	24
Insurance contract or identification number 124006 Number of Individuals Covered 8 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $181 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $36,264 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $181 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	23
Insurance contract or identification number 602148 Number of Individuals Covered 423 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $15,103 Total amount of fees paid to insurance company USD $2 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,003,711 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,103 Amount paid for insurance broker fees 2 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602772
Policy instance	10
Insurance contract or identification number 602772 Number of Individuals Covered 12 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $363 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $74,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $363 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	9
Insurance contract or identification number 600593 Number of Individuals Covered 1980 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $99,727 Total amount of fees paid to insurance company USD $9 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $19,930,489 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $99,727 Amount paid for insurance broker fees 9 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	8
Insurance contract or identification number 124008 Number of Individuals Covered 446 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $12,135 Total amount of fees paid to insurance company USD $2 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,440,257 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,135 Amount paid for insurance broker fees 2 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	7
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1751 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $37,515 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $500,198 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $37,515 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
SUTTER HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15107 )
Policy contract number	193802
Policy instance	6
Insurance contract or identification number 193802 Number of Individuals Covered 163 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $524,610 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	602771
Policy instance	5
Insurance contract or identification number 602771 Number of Individuals Covered 45 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,862 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $387,306 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,862 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	4
Insurance contract or identification number 1862 Number of Individuals Covered 12011 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 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	600554
Policy instance	3
Insurance contract or identification number 600554 Number of Individuals Covered 157 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $6,192 Total amount of fees paid to insurance company USD $1 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,234,427 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,192 Amount paid for insurance broker fees 1 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	227354
Policy instance	2
Insurance contract or identification number 227354 Number of Individuals Covered 54 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,011 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $225,147 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,011 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICE, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1928
Policy instance	1
Insurance contract or identification number 1928 Number of Individuals Covered 12 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 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	35519
Policy instance	11
Insurance contract or identification number 35519 Number of Individuals Covered 255 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $11,068 Total amount of fees paid to insurance company USD $1 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,219,423 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,068 Amount paid for insurance broker fees 1 Additional information about fees paid to insurance broker FEE Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	12
Insurance contract or identification number 2596 Number of Individuals Covered 4221 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	718697
Policy instance	22
Insurance contract or identification number 718697 Number of Individuals Covered 289 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,221,079 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	230360
Policy instance	21
Insurance contract or identification number 230360 Number of Individuals Covered 274 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $6,269 Total amount of fees paid to insurance company USD $1 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,280,829 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,269 Amount paid for insurance broker fees 1 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	20
Insurance contract or identification number 604306 Number of Individuals Covered 292 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $8,553 Total amount of fees paid to insurance company USD $1 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,702,320 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,553 Amount paid for insurance broker fees 1 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3208
Policy instance	19
Insurance contract or identification number 3208 Number of Individuals Covered 925 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Dental Insurance Welfare Benefit Yes 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 number	4215
Policy instance	18
Insurance contract or identification number 4215 Number of Individuals Covered 1930 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 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	600575
Policy instance	17
Insurance contract or identification number 600575 Number of Individuals Covered 163 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $5,960 Total amount of fees paid to insurance company USD $1 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,229,945 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,960 Amount paid for insurance broker fees 1 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	16
Insurance contract or identification number 0711956 Number of Individuals Covered 1976 Insurance policy start date 2016-11-01 Insurance policy end date 2017-10-31 Total amount of commissions paid to insurance broker USD $26,507 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $239,834 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,507 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	15
Insurance contract or identification number 600519 Number of Individuals Covered 74 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $6,929 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,369,303 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,929 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	14
Insurance contract or identification number 34925 Number of Individuals Covered 43 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,771 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $353,240 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,771 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	13
Insurance contract or identification number 228425 Number of Individuals Covered 21 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $628 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $128,673 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $628 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	31
Insurance contract or identification number 600819 Number of Individuals Covered 1015 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $155 Total amount of fees paid to insurance company USD $5 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,402,429 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $155 Amount paid for insurance broker fees 5 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	25
Insurance contract or identification number 36301 Number of Individuals Covered 57 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $501,817 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX641A,UX262A
Policy instance	47
Insurance contract or identification number UX641A,UX262A Number of Individuals Covered 4 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $82,363 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	36301
Policy instance	46
Insurance contract or identification number 36301 Number of Individuals Covered 61 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $3,710 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $638,800 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,710 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	45
Insurance contract or identification number 602165 Number of Individuals Covered 1411 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $55,587 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,232,021 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,587 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3208
Policy instance	44
Insurance contract or identification number 3208 Number of Individuals Covered 886 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $525,292 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 number	4215
Policy instance	43
Insurance contract or identification number 4215 Number of Individuals Covered 1602 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $991,391 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	231670
Policy instance	42
Insurance contract or identification number 231670 Number of Individuals Covered 830 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $23,896 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,363,726 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,896 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	41
Insurance contract or identification number 38655 Number of Individuals Covered 469 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $21,363 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,912,451 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,363 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	40
Insurance contract or identification number 1539 Number of Individuals Covered 487 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $299,075 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	603355
Policy instance	39
Insurance contract or identification number 603355 Number of Individuals Covered 720 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $23,453 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,267,601 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,453 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2441
Policy instance	38
Insurance contract or identification number 2441 Number of Individuals Covered 226 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 Total amount of commissions paid to insurance broker USD $3,611 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $120,368 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,611 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	37
Insurance contract or identification number 600593 Number of Individuals Covered 1662 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $71,722 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $13,596,491 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $71,722 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number	76614
Policy instance	48
Insurance contract or identification number 76614 Number of Individuals Covered 215 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $37,171 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	604306
Policy instance	50
Insurance contract or identification number 604306 Number of Individuals Covered 284 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $7,982 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,623,415 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,982 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	1
Insurance contract or identification number 35519 Number of Individuals Covered 394 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $19,411 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,637,338 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,411 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	2
Insurance contract or identification number 2288 Number of Individuals Covered 912 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $719,624 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 number	1928
Policy instance	3
Insurance contract or identification number 1928 Number of Individuals Covered 11 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,562 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	600519
Policy instance	4
Insurance contract or identification number 600519 Number of Individuals Covered 142 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $6,955 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,219,194 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,955 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	5
Insurance contract or identification number 1724 Number of Individuals Covered 128 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $94,290 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11634000
Policy instance	6
Insurance contract or identification number 11634000 Number of Individuals Covered 95 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $29,243 Total amount of fees paid to insurance company USD $13,003 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $292,171 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,448 Amount paid for insurance broker fees 13003 Insurance broker organization code? 3 Insurance broker name MGU OF THE WEST INS SVCS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	8
Insurance contract or identification number GL129620 Number of Individuals Covered 1280 Insurance policy start date 2014-02-01 Insurance policy end date 2015-01-31 Total amount of commissions paid to insurance broker USD $5,230 Total amount of fees paid to insurance company USD $631 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $52,301 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,230 Insurance broker organization code? 3 Amount paid for insurance broker fees 631 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker name NFP INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	54
Insurance contract or identification number 600575 Number of Individuals Covered 227 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $9,995 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,845,850 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,995 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	53
Insurance contract or identification number 602771 Number of Individuals Covered 31 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,290 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $260,754 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,290 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	52
Insurance contract or identification number 38654 Number of Individuals Covered 36 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,514 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $280,329 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,514 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35518
Policy instance	51
Insurance contract or identification number 35518 Number of Individuals Covered 20 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,308 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $241,672 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,308 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	36
Insurance contract or identification number 124009 Number of Individuals Covered 277 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $7,514 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,375,587 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,514 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	35
Insurance contract or identification number 8739 Number of Individuals Covered 1087 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $583,527 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	34925
Policy instance	20
Insurance contract or identification number 34925 Number of Individuals Covered 62 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,790 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $510,280 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,790 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	19
Insurance contract or identification number 603816 Number of Individuals Covered 2988 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $22,157,644 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	231427
Policy instance	18
Insurance contract or identification number 231427 Number of Individuals Covered 57 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,379 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $252,185 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,379 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0718697
Policy instance	17
Insurance contract or identification number 0718697 Number of Individuals Covered 411 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $3,796 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,264,791 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,796 Insurance broker organization code? 3 Insurance broker name TERA LOUISE CLIZBE
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	16
Insurance contract or identification number 124008 Number of Individuals Covered 463 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $12,357 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,293,772 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,357 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	15
Insurance contract or identification number 742364 Number of Individuals Covered 842 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $8,499 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $121,407 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,054 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	S04511
Policy instance	14
Insurance contract or identification number S04511 Number of Individuals Covered 288 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $76,413 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,597,219 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,967 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603178
Policy instance	13
Insurance contract or identification number 603178 Number of Individuals Covered 0 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $8,040 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $15,646 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,040 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	12
Insurance contract or identification number 1862 Number of Individuals Covered 13720 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,876,758 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	34837
Policy instance	9
Insurance contract or identification number 34837 Number of Individuals Covered 31 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,553 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $293,620 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,553 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	21
Insurance contract or identification number 34840 Number of Individuals Covered 255 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $11,559 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,094,598 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,559 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602772
Policy instance	23
Insurance contract or identification number 602772 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 $283 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $62,312 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $283 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	24
Insurance contract or identification number 228425 Number of Individuals Covered 15 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $412 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $79,147 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $412 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	34
Insurance contract or identification number VAR201237 Number of Individuals Covered 1280 Insurance policy start date 2014-02-01 Insurance policy end date 2015-01-31 Total amount of commissions paid to insurance broker USD $523 Total amount of fees paid to insurance company USD $63 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $5,230 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $523 Insurance broker organization code? 3 Amount paid for insurance broker fees 63 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker name NFP INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	33
Insurance contract or identification number 124006 Number of Individuals Covered 70 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,927 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $495,772 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,927 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	32
Insurance contract or identification number 602148 Number of Individuals Covered 385 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $15,361 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,628,622 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,361 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	31
Insurance contract or identification number 0711956 Number of Individuals Covered 1587 Insurance policy start date 2014-11-01 Insurance policy end date 2015-10-31 Total amount of commissions paid to insurance broker USD $19,883 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $165,689 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,503 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	30
Insurance contract or identification number 602030 Number of Individuals Covered 656 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $27,502 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,717,605 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,502 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	29
Insurance contract or identification number 600819 Number of Individuals Covered 1249 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $427 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,421,471 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $427 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	28
Insurance contract or identification number 600554 Number of Individuals Covered 150 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $6,582 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,210,523 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,582 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	27
Insurance contract or identification number 2596 Number of Individuals Covered 3777 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,586,637 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	602753
Policy instance	26
Insurance contract or identification number 602753 Number of Individuals Covered 618 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $25,865 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,796,781 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,865 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	25
Insurance contract or identification number 230360 Number of Individuals Covered 18 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $254 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $55,381 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $254 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3676
Policy instance	10
Insurance contract or identification number 3676 Number of Individuals Covered 7461 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,009,448 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	230502
Policy instance	7
Insurance contract or identification number 230502 Number of Individuals Covered 0 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $5,241 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,153 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,241 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	11
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1645 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $55,897 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $745,292 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,897 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711931
Policy instance	22
Insurance contract or identification number 0711931 Number of Individuals Covered 3005 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $47,444 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $395,370 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,058 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number	71422
Policy instance	49
Insurance contract or identification number 71422 Number of Individuals Covered 557 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,814 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $103,473 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,814 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3208
Policy instance	13
Insurance contract or identification number 3208 Number of Individuals Covered 925 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $9,817 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $485,923 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,817 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	14
Insurance contract or identification number 124008 Number of Individuals Covered 439 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $22,468 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,246,035 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,468 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	15
Insurance contract or identification number 602148 Number of Individuals Covered 358 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $21,164 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,658,618 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,164 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	16
Insurance contract or identification number 600575 Number of Individuals Covered 219 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $17,359 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,735,266 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,359 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0718697
Policy instance	17
Insurance contract or identification number 0718697 Number of Individuals Covered 293 Insurance policy start date 2014-02-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $30,329 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,888,515 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30,329 Insurance broker organization code? 3 Insurance broker name TERA LOUISE CLIZBE
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	4215
Policy instance	18
Insurance contract or identification number 4215 Number of Individuals Covered 1638 Insurance policy start date 2013-03-01 Insurance policy end date 2014-02-28 Total amount of commissions paid to insurance broker USD $27,179 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $980,881 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,179 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	7216
Policy instance	19
Insurance contract or identification number 7216 Number of Individuals Covered 2583 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $99,321 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,523,840 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $99,321 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	20
Insurance contract or identification number 602030 Number of Individuals Covered 2105 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $128,859 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $13,271,069 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $128,859 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	21
Insurance contract or identification number 34840 Number of Individuals Covered 274 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $23,251 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,304,706 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,251 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	12
Insurance contract or identification number 600554 Number of Individuals Covered 154 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $12,122 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,208,301 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,122 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603178
Policy instance	11
Insurance contract or identification number 603178 Number of Individuals Covered 1355 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $97,963 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,885,066 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $97,963 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	10
Insurance contract or identification number 600519 Number of Individuals Covered 187 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $19,060 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,867,454 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,060 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	3
Insurance contract or identification number 602753 Number of Individuals Covered 608 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $49,918 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,985,758 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $49,918 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	1
Insurance contract or identification number 1539 Number of Individuals Covered 489 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $4,990 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $287,988 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,990 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231427
Policy instance	2
Insurance contract or identification number 231427 Number of Individuals Covered 63 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,594 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $263,276 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,594 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	4
Insurance contract or identification number 0711956 Number of Individuals Covered 1300 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $19,418 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $161,821 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,117 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	5
Insurance contract or identification number 124006 Number of Individuals Covered 135 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $6,984 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $707,997 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,984 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	604306
Policy instance	6
Insurance contract or identification number 604306 Number of Individuals Covered 118 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $4,992 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $541,494 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,992 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9794
Policy instance	8
Insurance contract or identification number 9794 Number of Individuals Covered 421 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $7,863 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $286,124 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,863 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	7
Insurance contract or identification number 1724 Number of Individuals Covered 117 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,252 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $88,239 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,252 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number	76614
Policy instance	9
Insurance contract or identification number 76614 Number of Individuals Covered 223 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 Total amount of commissions paid to insurance broker USD $749 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,530 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $749 Insurance broker organization code? 4 Insurance broker name DUBLIN INSURANCE SERVICES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711931
Policy instance	22
Insurance contract or identification number 0711931 Number of Individuals Covered 2849 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $46,943 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $391,196 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,980 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	23
Insurance contract or identification number 34925 Number of Individuals Covered 66 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $7,281 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $700,577 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,281 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231670
Policy instance	24
Insurance contract or identification number 231670 Number of Individuals Covered 888 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $50,526 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,092,240 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $50,526 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2441
Policy instance	38
Insurance contract or identification number 2441 Number of Individuals Covered 237 Insurance policy start date 2014-04-01 Insurance policy end date 2014-03-31 Total amount of commissions paid to insurance broker USD $2,213 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $113,360 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,213 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230502
Policy instance	39
Insurance contract or identification number 230502 Number of Individuals Covered 1111 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $66,417 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,655,960 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $66,417 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	S04511
Policy instance	40
Insurance contract or identification number S04511 Number of Individuals Covered 275 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $72,123 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,503,765 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $72,123 Insurance broker organization code? 3 Insurance broker name CYNTHIA D. KRALJ
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11634000
Policy instance	41
Insurance contract or identification number 11634000 Number of Individuals Covered 99 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $37,351 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $407,020 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,278 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	42
Insurance contract or identification number VAR201237 Number of Individuals Covered 1281 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $547 Total amount of fees paid to insurance company USD $72 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $5,473 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $547 Amount paid for insurance broker fees 72 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	43
Insurance contract or identification number 8739 Number of Individuals Covered 1057 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 Total amount of commissions paid to insurance broker USD $10,276 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $539,572 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,276 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	44
Insurance contract or identification number 38655 Number of Individuals Covered 497 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $41,622 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,126,722 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $41,622 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	45
Insurance contract or identification number 2596 Number of Individuals Covered 3880 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $28,279 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,603,694 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $28,279 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	46
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1717 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $58,045 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $773,929 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $58,045 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	47
Insurance contract or identification number 36301 Number of Individuals Covered 115 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $10,662 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,039,948 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,662 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	36
Insurance contract or identification number 742364 Number of Individuals Covered 889 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $8,747 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $124,950 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,260 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	37
Insurance contract or identification number GL129620 Number of Individuals Covered 1281 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $5,460 Total amount of fees paid to insurance company USD $723 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $54,596 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,460 Amount paid for insurance broker fees 723 Additional information about fees paid to insurance broker ADMINISTRATIVE Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	35
Insurance contract or identification number 600593 Number of Individuals Covered 1352 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $123,253 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,277,346 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $123,253 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	25
Insurance contract or identification number 603355 Number of Individuals Covered 859 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $43,950 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,447,187 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $43,950 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX641A,UX262A
Policy instance	26
Insurance contract or identification number UX641A,UX262A Number of Individuals Covered 7 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $152,117 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	602165
Policy instance	27
Insurance contract or identification number 602165 Number of Individuals Covered 1474 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $88,584 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,147,922 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $88,584 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1928
Policy instance	28
Insurance contract or identification number 1928 Number of Individuals Covered 6 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $390 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,966 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $390 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	29
Insurance contract or identification number 2288 Number of Individuals Covered 990 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $18,729 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $754,324 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,729 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	30
Insurance contract or identification number 600819 Number of Individuals Covered 1503 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,377,093 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 number	1862
Policy instance	31
Insurance contract or identification number 1862 Number of Individuals Covered 14589 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $186,086 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,089,577 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $186,086 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	32
Insurance contract or identification number 35519 Number of Individuals Covered 415 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $35,326 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,485,048 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $35,326 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	33
Insurance contract or identification number 603816 Number of Individuals Covered 2855 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $21,220,965 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number	71422
Policy instance	34
Insurance contract or identification number 71422 Number of Individuals Covered 1040 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $3,324 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $45,213 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,324 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	48
Insurance contract or identification number 124009 Number of Individuals Covered 290 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $16,066 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,523,606 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,066 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	37
Insurance contract or identification number GL129620 Number of Individuals Covered 1373 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $5,781 Total amount of fees paid to insurance company USD $712 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $57,806 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,781 Insurance broker organization code? 3 Amount paid for insurance broker fees 712 Additional information about fees paid to insurance broker GENERAL AGENT SERVICE Insurance broker name NFP INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	15
Insurance contract or identification number 600519 Number of Individuals Covered 532 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $29,119 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,644,449 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,119 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	227354
Policy instance	16
Insurance contract or identification number 227354 Number of Individuals Covered 57 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $182 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $44,000 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $182 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9794
Policy instance	17
Insurance contract or identification number 9794 Number of Individuals Covered 491 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $8,559 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $310,310 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,559 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	18
Insurance contract or identification number 2288 Number of Individuals Covered 1094 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $24,272 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $809,080 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,272 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3208
Policy instance	19
Insurance contract or identification number 3208 Number of Individuals Covered 889 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $14,556 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $485,198 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,556 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	54
Insurance contract or identification number 124006 Number of Individuals Covered 132 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $5,421 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $665,707 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,421 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1928
Policy instance	53
Insurance contract or identification number 1928 Number of Individuals Covered 6 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $162 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,411 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $162 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600575
Policy instance	52
Insurance contract or identification number 600575 Number of Individuals Covered 301 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $15,225 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,814,974 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,225 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	51
Insurance contract or identification number 600554 Number of Individuals Covered 216 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $11,693 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,369,735 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,693 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	50
Insurance contract or identification number 34840 Number of Individuals Covered 597 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $46,237 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,691,190 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $46,237 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230502
Policy instance	49
Insurance contract or identification number 230502 Number of Individuals Covered 1044 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $46,693 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,893,661 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $46,693 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	14
Insurance contract or identification number 2596 Number of Individuals Covered 4012 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $44,857 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,632,343 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $44,857 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	4215
Policy instance	13
Insurance contract or identification number 4215 Number of Individuals Covered 1805 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $34,363 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,145,444 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,363 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	12
Insurance contract or identification number 742364 Number of Individuals Covered 770 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $7,333 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $104,755 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,086 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602148
Policy instance	1
Insurance contract or identification number 602148 Number of Individuals Covered 279 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $12,363 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,557,684 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,363 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	2
Insurance contract or identification number 8739 Number of Individuals Covered 987 Insurance policy start date 2012-08-01 Insurance policy end date 2013-07-31 Total amount of commissions paid to insurance broker USD $17,995 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $644,233 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,995 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	3
Insurance contract or identification number 36301 Number of Individuals Covered 182 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $12,689 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,520,112 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,689 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	4
Insurance contract or identification number 602753 Number of Individuals Covered 699 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $39,501 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,964,411 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,501 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	5
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 1634 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $29,640 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $537,097 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,640 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	6
Insurance contract or identification number 38654 Number of Individuals Covered 75 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $4,118 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $493,339 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,118 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34837
Policy instance	8
Insurance contract or identification number 34837 Number of Individuals Covered 22 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $1,756 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $219,474 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,756 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3676
Policy instance	7
Insurance contract or identification number 3676 Number of Individuals Covered 6216 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $100,297 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,343,243 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $100,297 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	SC045100
Policy instance	9
Insurance contract or identification number SC045100 Number of Individuals Covered 296 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $79,259 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,507,604 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,002 Insurance broker organization code? 3 Insurance broker name CYNTHIA D. KRALJ
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	10
Insurance contract or identification number 1862 Number of Individuals Covered 14497 Insurance policy start date 2012-08-01 Insurance policy end date 2013-07-31 Total amount of commissions paid to insurance broker USD $215,671 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,193,303 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $215,671 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35518
Policy instance	11
Insurance contract or identification number 35518 Number of Individuals Covered 32 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $2,439 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $307,435 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,439 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602771
Policy instance	48
Insurance contract or identification number 602771 Number of Individuals Covered 54 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $2,107 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $275,419 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,107 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	47
Insurance contract or identification number VAR201237 Number of Individuals Covered 1311 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $577 Total amount of fees paid to insurance company USD $77 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $5,769 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $577 Insurance broker organization code? 3 Amount paid for insurance broker fees 77 Additional information about fees paid to insurance broker GENERAL AGENT SERVICE Insurance broker name NFP INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	32
Insurance contract or identification number 602030 Number of Individuals Covered 1578 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $66,092 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,311,025 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $66,092 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	89497000
Policy instance	31
Insurance contract or identification number 89497000 Number of Individuals Covered 316 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $16,934 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $357,353 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,467 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	29
Insurance contract or identification number 0711956 Number of Individuals Covered 1523 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $23,582 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $182,259 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,573 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11634000
Policy instance	28
Insurance contract or identification number 11634000 Number of Individuals Covered 115 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $13,118 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $407,023 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,527 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	27
Insurance contract or identification number 230360 Number of Individuals Covered 0 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $30 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,716 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602165
Policy instance	30
Insurance contract or identification number 602165 Number of Individuals Covered 1062 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $40,059 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,403,550 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $40,059 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	26
Insurance contract or identification number 124009 Number of Individuals Covered 192 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $7,126 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $870,553 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,126 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	25
Insurance contract or identification number 34925 Number of Individuals Covered 110 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $11,205 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,322,356 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,205 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	231427
Policy instance	24
Insurance contract or identification number 231427 Number of Individuals Covered 50 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $295 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,277 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $295 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	11739000
Policy instance	23
Insurance contract or identification number 11739000 Number of Individuals Covered 131 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $19,620 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $421,514 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,810 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	22
Insurance contract or identification number 600593 Number of Individuals Covered 1494 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $95,751 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,050,085 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $95,751 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	21
Insurance contract or identification number 603355 Number of Individuals Covered 190 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $9,828 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,246,394 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,828 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0718697
Policy instance	33
Insurance contract or identification number 0718697 Number of Individuals Covered 741 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $28,390 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,708,935 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $28,390 Insurance broker organization code? 3 Insurance broker name TERA LOUISE CLIZBE
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	FOOTNOTE 1
Policy instance	35
Insurance contract or identification number FOOTNOTE 1 Number of Individuals Covered 8 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $146,139 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	124008
Policy instance	34
Insurance contract or identification number 124008 Number of Individuals Covered 428 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $14,069 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,852,301 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,069 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	45
Insurance contract or identification number 1724 Number of Individuals Covered 125 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $2,713 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $90,448 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,713 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	44
Insurance contract or identification number 38655 Number of Individuals Covered 970 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $55,805 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,878,119 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,805 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34924
Policy instance	43
Insurance contract or identification number 34924 Number of Individuals Covered 0 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $43 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,600 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $43 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	42
Insurance contract or identification number 228425 Number of Individuals Covered 8 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $268 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $37,713 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $268 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	41
Insurance contract or identification number 35519 Number of Individuals Covered 466 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $33,446 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,081,156 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $33,446 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711931
Policy instance	46
Insurance contract or identification number 0711931 Number of Individuals Covered 2724 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $43,299 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $360,824 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,361 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	40
Insurance contract or identification number 600819 Number of Individuals Covered 1697 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $332 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,338,422 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $332 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603816
Policy instance	39
Insurance contract or identification number 603816 Number of Individuals Covered 2670 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $19,104,523 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 number	1539
Policy instance	38
Insurance contract or identification number 1539 Number of Individuals Covered 481 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $8,735 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $291,176 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,735 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2441
Policy instance	20
Insurance contract or identification number 2441 Number of Individuals Covered 232 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $3,354 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $111,815 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,354 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603178
Policy instance	36
Insurance contract or identification number 603178 Number of Individuals Covered 1250 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $63,661 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,027,200 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $63,661 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX641A
Policy instance	36
Insurance contract or identification number UX641A Number of Individuals Covered 6 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $81,515 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	742364
Policy instance	37
Insurance contract or identification number 742364 Number of Individuals Covered 752 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $7,522 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $107,459 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,243 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3208
Policy instance	38
Insurance contract or identification number 3208 Number of Individuals Covered 992 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $15,312 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $510,405 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,312 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2441
Policy instance	39
Insurance contract or identification number 2441 Number of Individuals Covered 249 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $2,926 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $97,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,926 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711931
Policy instance	35
Insurance contract or identification number 0711931 Number of Individuals Covered 2759 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $52,793 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $405,065 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,263 Insurance broker organization code? 3 Insurance broker name DRIVER ALLIANT INSURANCE SRVCS, INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2288
Policy instance	40
Insurance contract or identification number 2288 Number of Individuals Covered 1003 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $22,052 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $735,068 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,052 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	MG-103 18398
Policy instance	34
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 943 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $21,233 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $424,652 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,233 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1724
Policy instance	33
Insurance contract or identification number 1724 Number of Individuals Covered 109 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $2,351 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $78,363 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,351 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UY428A
Policy instance	32
Insurance contract or identification number UY428A Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $31,190 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	602165
Policy instance	31
Insurance contract or identification number 602165 Number of Individuals Covered 1002 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $46,938 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,794,916 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $46,938 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602030
Policy instance	29
Insurance contract or identification number 602030 Number of Individuals Covered 1361 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $56,627 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,911,441 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,627 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1539
Policy instance	28
Insurance contract or identification number 1539 Number of Individuals Covered 458 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $8,032 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $267,727 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,032 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX262A
Policy instance	41
Insurance contract or identification number UX262A Number of Individuals Covered 4 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $52,217 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	602771
Policy instance	42
Insurance contract or identification number 602771 Number of Individuals Covered 25 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $1,376 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $173,484 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,376 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603355
Policy instance	54
Insurance contract or identification number 603355 Number of Individuals Covered 195 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $7,670 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,043,143 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,670 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	53
Insurance contract or identification number VAR201237 Number of Individuals Covered 1301 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $633 Total amount of fees paid to insurance company USD $70 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $5,629 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $563 Amount paid for insurance broker fees 70 Insurance broker organization code? 3 Additional information about fees paid to insurance broker GENERAL AGENT SERVICE Insurance broker name NFP INSURANCE SERVICES INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0718697
Policy instance	52
Insurance contract or identification number 0718697 Number of Individuals Covered 741 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $25,457 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,950,296 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,223 Insurance broker organization code? 3 Insurance broker name TERA LOUISE CLIZBE
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1928
Policy instance	51
Insurance contract or identification number 1928 Number of Individuals Covered 38 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $735 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $24,499 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $735 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600593
Policy instance	50
Insurance contract or identification number 600593 Number of Individuals Covered 1614 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $88,496 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,877,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $88,496 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	49
Insurance contract or identification number 0711956 Number of Individuals Covered 1452 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $19,781 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $179,094 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,418 Insurance broker organization code? 3 Insurance broker name NANCY ELLEN GYLES
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	SC045100
Policy instance	48
Insurance contract or identification number SC045100 Number of Individuals Covered 290 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $73,519 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,336,175 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,591 Insurance broker organization code? 3 Insurance broker name CYNTHIA D. KRALJ
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	1862
Policy instance	47
Insurance contract or identification number 1862 Number of Individuals Covered 14557 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $217,335 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,244,509 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $217,335 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230360
Policy instance	46
Insurance contract or identification number 230360 Number of Individuals Covered 1 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $214 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,400 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $214 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34837
Policy instance	45
Insurance contract or identification number 34837 Number of Individuals Covered 24 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $1,451 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $185,934 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,451 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600819
Policy instance	44
Insurance contract or identification number 600819 Number of Individuals Covered 999 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,757,502 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	602148
Policy instance	43
Insurance contract or identification number 602148 Number of Individuals Covered 233 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $10,619 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,315,256 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,619 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	89497
Policy instance	1
Insurance contract or identification number 89497 Number of Individuals Covered 534 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $114,483 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,251,022 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $51,932 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	230502
Policy instance	27
Insurance contract or identification number 230502 Number of Individuals Covered 980 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $41,431 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,527,689 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $41,431 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602753
Policy instance	26
Insurance contract or identification number 602753 Number of Individuals Covered 784 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $39,220 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,804,364 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,220 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35518
Policy instance	12
Insurance contract or identification number 35518 Number of Individuals Covered 34 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $2,362 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $292,314 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,362 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	228425
Policy instance	11
Insurance contract or identification number 228425 Number of Individuals Covered 6 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $293 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $29,579 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $293 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34924
Policy instance	10
Insurance contract or identification number 34924 Number of Individuals Covered 1 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $87 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,512 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $87 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	9
Insurance contract or identification number GL129620 Number of Individuals Covered 1301 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $5,629 Total amount of fees paid to insurance company USD $690 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $56,293 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,629 Insurance broker organization code? 3 Amount paid for insurance broker fees 690 Additional information about fees paid to insurance broker GENERAL AGENT SERVICE Insurance broker name NFP INSURANCE SERVICES INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	2596
Policy instance	8
Insurance contract or identification number 2596 Number of Individuals Covered 3986 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $48,561 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,618,713 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $48,561 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3676
Policy instance	7
Insurance contract or identification number 3676 Number of Individuals Covered 5990 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $94,357 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,145,232 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $94,357 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	4215
Policy instance	6
Insurance contract or identification number 4215 Number of Individuals Covered 1807 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $39,402 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,313,391 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,402 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8661
Policy instance	4
Insurance contract or identification number 8661 Number of Individuals Covered 313 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $6,980 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $232,678 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,980 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	8739
Policy instance	5
Insurance contract or identification number 8739 Number of Individuals Covered 1261 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $20,272 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $675,739 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,272 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9794
Policy instance	3
Insurance contract or identification number 9794 Number of Individuals Covered 500 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $9,334 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $311,125 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,334 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	89379
Policy instance	2
Insurance contract or identification number 89379 Number of Individuals Covered 137 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $35,004 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $500,046 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,502 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	603178
Policy instance	30
Insurance contract or identification number 603178 Number of Individuals Covered 1302 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $59,854 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,471,754 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $59,854 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38654
Policy instance	13
Insurance contract or identification number 38654 Number of Individuals Covered 84 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $5,559 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $665,760 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,559 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UY806A
Policy instance	14
Insurance contract or identification number UY806A Number of Individuals Covered 0 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,406 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	600575
Policy instance	25
Insurance contract or identification number 600575 Number of Individuals Covered 448 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $24,501 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,014,731 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,501 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600554
Policy instance	24
Insurance contract or identification number 600554 Number of Individuals Covered 236 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $8,682 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,088,165 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,682 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	600519
Policy instance	23
Insurance contract or identification number 600519 Number of Individuals Covered 489 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $25,090 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,117,716 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,090 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124009
Policy instance	22
Insurance contract or identification number 124009 Number of Individuals Covered 190 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $5,177 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $675,458 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,177 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124008
Policy instance	21
Insurance contract or identification number 124008 Number of Individuals Covered 139 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $6,131 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $710,177 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,131 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	124006
Policy instance	20
Insurance contract or identification number 124006 Number of Individuals Covered 137 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $5,462 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $666,884 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,462 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	38655
Policy instance	19
Insurance contract or identification number 38655 Number of Individuals Covered 1008 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $53,266 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,772,575 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $53,266 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	15
Insurance contract or identification number 34840 Number of Individuals Covered 903 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $43,474 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,457,030 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $43,474 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34925
Policy instance	16
Insurance contract or identification number 34925 Number of Individuals Covered 248 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $11,991 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,502,121 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,991 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35519
Policy instance	17
Insurance contract or identification number 35519 Number of Individuals Covered 718 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $43,133 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,278,590 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $43,133 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	36301
Policy instance	18
Insurance contract or identification number 36301 Number of Individuals Covered 245 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $17,426 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,101,557 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,426 Insurance broker organization code? 3 Insurance broker name DUBLIN INSURANCE SERVICES, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	35518
Policy instance	40
Insurance contract or identification number 35518 Number of Individuals Covered 35 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $2,131 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $273,269 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	34839
Policy instance	39
Insurance contract or identification number 34839 Number of Individuals Covered 6 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $1,228 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $137,270 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	34837
Policy instance	38
Insurance contract or identification number 34837 Number of Individuals Covered 17 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $1,216 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $163,799 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	228425
Policy instance	37
Insurance contract or identification number 228425 Number of Individuals Covered 7 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $144 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $19,286 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	34924
Policy instance	36
Insurance contract or identification number 34924 Number of Individuals Covered 1 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $207 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $25,935 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	602771
Policy instance	35
Insurance contract or identification number 602771 Number of Individuals Covered 22 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $690 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $97,098 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 number	1862
Policy instance	34
Insurance contract or identification number 1862 Number of Individuals Covered 8488 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	8739
Policy instance	33
Insurance contract or identification number 8739 Number of Individuals Covered 655 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	2288
Policy instance	32
Insurance contract or identification number 2288 Number of Individuals Covered 423 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	3208
Policy instance	31
Insurance contract or identification number 3208 Number of Individuals Covered 705 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	11254
Policy instance	30
Insurance contract or identification number 11254 Number of Individuals Covered 127 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	2441
Policy instance	29
Insurance contract or identification number 2441 Number of Individuals Covered 296 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 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	230502
Policy instance	41
Insurance contract or identification number 230502 Number of Individuals Covered 988 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $44,085 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,561,513 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	603178
Policy instance	42
Insurance contract or identification number 603178 Number of Individuals Covered 1247 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $53,932 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,869,156 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	36301
Policy instance	43
Insurance contract or identification number 36301 Number of Individuals Covered 307 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $21,141 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,645,825 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	SC045100
Policy instance	55
Insurance contract or identification number SC045100 Number of Individuals Covered 227 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $64,609 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,140,017 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	89497
Policy instance	54
Insurance contract or identification number 89497 Number of Individuals Covered 577 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $91,718 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,378,505
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	53
Insurance contract or identification number GL129620 Number of Individuals Covered 1043 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $5,967 Total amount of fees paid to insurance company USD $734 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $59,669 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX262A
Policy instance	52
Insurance contract or identification number UX262A Number of Individuals Covered 3 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $34,701 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UY428A
Policy instance	51
Insurance contract or identification number UY428A Number of Individuals Covered 4 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $39,875 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	600593
Policy instance	49
Insurance contract or identification number 600593 Number of Individuals Covered 1522 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $88,657 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,402,261 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0718697
Policy instance	48
Insurance contract or identification number 0718697 Number of Individuals Covered 721 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,918,194 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	602165
Policy instance	47
Insurance contract or identification number 602165 Number of Individuals Covered 1001 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $42,592 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,402,895 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	600554
Policy instance	46
Insurance contract or identification number 600554 Number of Individuals Covered 198 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $11,652 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,416,058 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	602030
Policy instance	50
Insurance contract or identification number 602030 Number of Individuals Covered 1452 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $57,272 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,076,750 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	124008
Policy instance	45
Insurance contract or identification number 124008 Number of Individuals Covered 128 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $7,015 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $700,240 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	38655
Policy instance	44
Insurance contract or identification number 38655 Number of Individuals Covered 1081 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $57,168 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,199,030 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 number	1724
Policy instance	27
Insurance contract or identification number 1724 Number of Individuals Covered 105 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	7628
Policy instance	28
Insurance contract or identification number 7628 Number of Individuals Covered 797 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 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	600519
Policy instance	12
Insurance contract or identification number 600519 Number of Individuals Covered 495 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $21,283 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,779,174 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	34925
Policy instance	11
Insurance contract or identification number 34925 Number of Individuals Covered 225 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $10,485 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,352,734 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 number	8661
Policy instance	10
Insurance contract or identification number 8661 Number of Individuals Covered 155 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 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	230360
Policy instance	9
Insurance contract or identification number 230360 Number of Individuals Covered 2 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $97 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,906 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 number	2366
Policy instance	8
Insurance contract or identification number 2366 Number of Individuals Covered 421 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	1539
Policy instance	7
Insurance contract or identification number 1539 Number of Individuals Covered 179 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract number	942660
Policy instance	6
Insurance contract or identification number 942660 Number of Individuals Covered 2 Insurance policy start date 2011-01-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $1,185 Total amount of fees paid to insurance company USD $474 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $23,696 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX641A
Policy instance	5
Insurance contract or identification number UX641A Number of Individuals Covered 11 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $97,773 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	600819
Policy instance	4
Insurance contract or identification number 600819 Number of Individuals Covered 992 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,268,074 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UY806A
Policy instance	3
Insurance contract or identification number UY806A Number of Individuals Covered 2 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,473 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	2
Insurance contract or identification number 0711956 Number of Individuals Covered 1655 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $23,284 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181,440 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 number	MG-103 18398
Policy instance	1
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 960 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $21,486 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $429,730 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	34840
Policy instance	13
Insurance contract or identification number 34840 Number of Individuals Covered 792 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $41,263 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,245,570 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	35519
Policy instance	14
Insurance contract or identification number 35519 Number of Individuals Covered 838 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $40,782 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,256,602 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	26
Insurance contract or identification number VAR201237 Number of Individuals Covered 1043 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $654 Total amount of fees paid to insurance company USD $66 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $6,539 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 number	3676
Policy instance	25
Insurance contract or identification number 3676 Number of Individuals Covered 2144 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	9794
Policy instance	24
Insurance contract or identification number 9794 Number of Individuals Covered 369 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	4215
Policy instance	23
Insurance contract or identification number 4215 Number of Individuals Covered 718 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	1928
Policy instance	22
Insurance contract or identification number 1928 Number of Individuals Covered 30 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Dental Insurance Welfare Benefit Yes 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 number	2596
Policy instance	21
Insurance contract or identification number 2596 Number of Individuals Covered 1403 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 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	602148
Policy instance	20
Insurance contract or identification number 602148 Number of Individuals Covered 220 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $8,566 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,131,759 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	602753
Policy instance	19
Insurance contract or identification number 602753 Number of Individuals Covered 864 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $38,424 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,909,824 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	600575
Policy instance	18
Insurance contract or identification number 600575 Number of Individuals Covered 497 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $24,284 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,149,761 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	124006
Policy instance	17
Insurance contract or identification number 124006 Number of Individuals Covered 138 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $5,528 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $762,132 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	124009
Policy instance	16
Insurance contract or identification number 124009 Number of Individuals Covered 50 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $1,894 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $263,966 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	38654
Policy instance	15
Insurance contract or identification number 38654 Number of Individuals Covered 110 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $5,874 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $745,063 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CHINESE COMMUNITY HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	SC045100
Policy instance	41
Insurance contract or identification number SC045100 Number of Individuals Covered 287 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $67,585 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,152,944 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UY806A
Policy instance	74
Insurance contract or identification number UY806A Number of Individuals Covered 2 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $18,771 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	600575
Policy instance	55
Insurance contract or identification number 600575 Number of Individuals Covered 460 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $29,605 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,676,642 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	65936B
Policy instance	54
Insurance contract or identification number 65936B 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,998 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	34837
Policy instance	53
Insurance contract or identification number 34837 Number of Individuals Covered 29 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $2,228 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $227,843 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	391451
Policy instance	52
Insurance contract or identification number 391451 Number of Individuals Covered 2 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,334 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	61607A
Policy instance	51
Insurance contract or identification number 61607A 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $116,289 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	600593
Policy instance	50
Insurance contract or identification number 600593 Number of Individuals Covered 1656 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $60,134 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,863,919 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	602165
Policy instance	49
Insurance contract or identification number 602165 Number of Individuals Covered 1000 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $52,727 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,809,290 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	35519
Policy instance	48
Insurance contract or identification number 35519 Number of Individuals Covered 780 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $46,907 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,244,965 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 number	2441
Policy instance	47
Insurance contract or identification number 2441 Number of Individuals Covered 299 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $2,277 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	603178
Policy instance	46
Insurance contract or identification number 603178 Number of Individuals Covered 1224 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $11,525 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,895,954 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	61607E
Policy instance	45
Insurance contract or identification number 61607E 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,722 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	65936J
Policy instance	44
Insurance contract or identification number 65936J 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,452 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	34839
Policy instance	43
Insurance contract or identification number 34839 Number of Individuals Covered 42 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $3,278 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $255,848 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 number	8661
Policy instance	42
Insurance contract or identification number 8661 Number of Individuals Covered 157 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 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	62003D
Policy instance	39
Insurance contract or identification number 62003D 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,819 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 number	2366
Policy instance	38
Insurance contract or identification number 2366 Number of Individuals Covered 430 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $10,030 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
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR201237
Policy instance	56
Insurance contract or identification number VAR201237 Number of Individuals Covered 1055 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $459 Total amount of fees paid to insurance company USD $47 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $4,541 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	34925
Policy instance	57
Insurance contract or identification number 34925 Number of Individuals Covered 217 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $26,116 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,090,507 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	600519
Policy instance	73
Insurance contract or identification number 600519 Number of Individuals Covered 484 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $22,919 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,257,338 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	36301
Policy instance	72
Insurance contract or identification number 36301 Number of Individuals Covered 461 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $32,357 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,934,458 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	602753
Policy instance	71
Insurance contract or identification number 602753 Number of Individuals Covered 834 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $46,573 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,214,483 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX641A
Policy instance	70
Insurance contract or identification number UX641A Number of Individuals Covered 11 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $77,730 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 number	1928
Policy instance	69
Insurance contract or identification number 1928 Number of Individuals Covered 27 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 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	34924
Policy instance	68
Insurance contract or identification number 34924 Number of Individuals Covered 7 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $3,152 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $271,944 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 number	3722
Policy instance	67
Insurance contract or identification number 3722 Number of Individuals Covered 135 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 Dental Insurance Welfare Benefit Yes 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 number	2288
Policy instance	66
Insurance contract or identification number 2288 Number of Individuals Covered 458 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 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	230360
Policy instance	65
Insurance contract or identification number 230360 Number of Individuals Covered 2 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $17,649 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,227,114 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 number	9794
Policy instance	64
Insurance contract or identification number 9794 Number of Individuals Covered 372 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 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	600554
Policy instance	63
Insurance contract or identification number 600554 Number of Individuals Covered 341 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $18,281 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,704,736 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	48345
Policy instance	62
Insurance contract or identification number 48345 Number of Individuals Covered 0 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $5,234 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $280,222 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	38654
Policy instance	61
Insurance contract or identification number 38654 Number of Individuals Covered 129 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $12,960 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $970,843 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0711956
Policy instance	60
Insurance contract or identification number 0711956 Number of Individuals Covered 1578 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $21,181 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $173,341 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	124006
Policy instance	59
Insurance contract or identification number 124006 Number of Individuals Covered 160 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $16,190 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $666,530 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	62003C
Policy instance	58
Insurance contract or identification number 62003C 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,880 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	62003B
Policy instance	37
Insurance contract or identification number 62003B 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,070 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 number	4215
Policy instance	36
Insurance contract or identification number 4215 Number of Individuals Covered 740 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 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	124008
Policy instance	35
Insurance contract or identification number 124008 Number of Individuals Covered 133 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $11,868 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $533,106 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 number	1539
Policy instance	16
Insurance contract or identification number 1539 Number of Individuals Covered 176 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 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract number	942660
Policy instance	15
Insurance contract or identification number 942660 Number of Individuals Covered 2 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $1,185 Total amount of fees paid to insurance company USD $885 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $44,263 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	65936H
Policy instance	14
Insurance contract or identification number 65936H 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $39,513 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	124009
Policy instance	13
Insurance contract or identification number 124009 Number of Individuals Covered 54 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $8,118 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $311,636 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 number	7628
Policy instance	12
Insurance contract or identification number 7628 Number of Individuals Covered 796 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $23,774 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	35518
Policy instance	11
Insurance contract or identification number 35518 Number of Individuals Covered 36 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $2,566 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $256,153 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	62003V
Policy instance	10
Insurance contract or identification number 62003V 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,433 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	228425
Policy instance	9
Insurance contract or identification number 228425 Number of Individuals Covered 5 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $1,244 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $32,200 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	N3060B
Policy instance	8
Insurance contract or identification number N3060B 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $13,549 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UX262A
Policy instance	7
Insurance contract or identification number UX262A Number of Individuals Covered 5 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $34,917 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 number	1724
Policy instance	6
Insurance contract or identification number 1724 Number of Individuals Covered 97 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 Dental Insurance Welfare Benefit Yes 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 number	8739
Policy instance	5
Insurance contract or identification number 8739 Number of Individuals Covered 662 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 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	61607D
Policy instance	4
Insurance contract or identification number 61607D 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,408 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 number	3208
Policy instance	3
Insurance contract or identification number 3208 Number of Individuals Covered 744 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 Dental Insurance Welfare Benefit Yes 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 number	2596
Policy instance	2
Insurance contract or identification number 2596 Number of Individuals Covered 1685 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 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	62003A
Policy instance	1
Insurance contract or identification number 62003A 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,636 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	61607J
Policy instance	17
Insurance contract or identification number 61607J 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,792 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	N3060D
Policy instance	18
Insurance contract or identification number N3060D 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $15,990 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	N3060H
Policy instance	34
Insurance contract or identification number N3060H 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,527 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	UY428A
Policy instance	33
Insurance contract or identification number UY428A Number of Individuals Covered 6 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $46,859 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	N3060K
Policy instance	32
Insurance contract or identification number N3060K 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $32,259 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	602030
Policy instance	31
Insurance contract or identification number 602030 Number of Individuals Covered 2166 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $126,710 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,836,076 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	602148
Policy instance	30
Insurance contract or identification number 602148 Number of Individuals Covered 127 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $6,002 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $601,782 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL129620
Policy instance	29
Insurance contract or identification number GL129620 Number of Individuals Covered 1091 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $5,173 Total amount of fees paid to insurance company USD $474 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $51,186 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	38655
Policy instance	28
Insurance contract or identification number 38655 Number of Individuals Covered 1412 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $80,834 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,560,553 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	65936F
Policy instance	27
Insurance contract or identification number 65936F 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,494 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	N3060A
Policy instance	26
Insurance contract or identification number N3060A 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $167,556 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number	65936A
Policy instance	25
Insurance contract or identification number 65936A 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $18,784 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number	89497
Policy instance	24
Insurance contract or identification number 89497 Number of Individuals Covered 599 Insurance policy start date 2010-06-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $44,990 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $899,811 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	34840
Policy instance	23
Insurance contract or identification number 34840 Number of Individuals Covered 986 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $66,621 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,073,605 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 number	1862
Policy instance	22
Insurance contract or identification number 1862 Number of Individuals Covered 8887 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 Dental Insurance Welfare Benefit Yes 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 number	3676
Policy instance	21
Insurance contract or identification number 3676 Number of Individuals Covered 2175 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 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	600819
Policy instance	20
Insurance contract or identification number 600819 Number of Individuals Covered 1038 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $12,125 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,397,277 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 number	MG-103 18398
Policy instance	19
Insurance contract or identification number MG-103 18398 Number of Individuals Covered 989 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $17,964 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $427,353 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	230502
Policy instance	40
Insurance contract or identification number 230502 Number of Individuals Covered 970 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $21,009 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,513,405 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

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• HEALTH CARE CAPITAL CONS INC 401(K) PROFIT SHARING PLAN & TRUST [EIN = 582053875]
• HEALTH CARE LOGISTICS, INC 401(K) PLAN [EIN = 310942682]
• HEALTH CARE MANAGEMENT SYSTEMS, INC. 401(K) PLAN [EIN = 431342874]
• HEALTH CARE PLAN FOR THE EMPLOYEES OF COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED [EIN = 161317369]
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• HEALTH CARE AND REHABILITATION SERVICES OF SOUTHEASTERN VERMONT [EIN = 237017624]
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• HEALTH CARE FLEXIBLE SPENDING ACCOUNT [EIN = 314392702]
• HEALTH CARE SPENDING ACCOUNT FOR EMPLOYEES OF HARLEY-DAVIDSON MOTOR CO GROUP LLC [EIN = 391805420]
• HEALTH CARE PLAN [EIN = 410971937]
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• HEALTH CARE BENEFITS PLAN FOR RETIREES OFFERED BY W F RETIREES HEALTH TRUST [EIN = 752396970]
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• HEALTH CARE REIMBURSEMENT ACCOUNT [EIN = 274034515]
• HEALTH CARE RESOURCES, INC. WELFARE BENEFIT PLAN [EIN = 043219227]
• HEALTH CARE PLAN OF LEES-MCRAE COLLEGE [EIN = 560529953]
• HEALTH CARE MEDICAL BENEFITS PLAN [EIN = 581815587]
• HEALTH CARE NAVIGATOR 401(K) PLAN [EIN = 260302748]
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• HEALTH CARE STRATEGIES, L.L.C. EMPLOYEE 401(K) PLAN [EIN = 752656126]
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• HEALTH CARE STRATEGIES, INC. 401(K) PROFIT SHARING PLAN [EIN = 581511741]
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• HEALTH CARE PROGRAM APPENDIX D - VISION COVERAGE [EIN = 382772023]
• HEALTH CARE PROGRAM APPENDIX C DENTAL COVERAGE [EIN = 382772023]
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• HEALTH CARE PROGRAM EXHIBIT C & C-1 [EIN = 382772023]
• HEALTH CARE FOR WOMEN 401(K) PLAN [EIN = 820488070]
• HEALTH CARE PLAN OF SKC, INC. [EIN = 251103687]
• HEALTH CARE PHARMACY OF PERRYVILLE MCF BENEFIT PLAN [EIN = 821113652]
• HEALTH CARE WITHOUT HARM RETIREMENT PLAN [EIN = 522358837]
• HEALTH CARE FSA, DEPENDENT CARE FSA [EIN = 522056410]
• HEALTH CARE ADVOCATES INTERNATIONAL, LLC 401(K) RETIREMENT PLAN [EIN = 814538081]
• HEALTH CARE AMENITIES PLUS, INC. 401(K) PROFIT SHARING PLAN & TRUST [EIN = 752613677]
• HEALTH CARE LEGAL SERVICES, INC. PROFIT SHARING 401K PLAN [EIN = 330297047]
• HEALTH CARE INTRANET TECHNOLOGIES, INC. 401K RETIREMENT PLAN [EIN = 522102111]
• HEALTH CARE PARTNERS, INC. 401(K) PLAN [EIN = 383607271]
• HEALTH CARE MANAGEMENT GROUP [EIN = 522072830]
• HEALTH CARE PLAN OF GEORGE, MILES & BUHR [EIN = 520740145]
• HEALTH CARE INFORMATION SERVICE LLC 125 BENEFIT PLAN [EIN = 364089115]
• HEALTH CARE REIMBURSEMENT FOR EMPLOYEES OF TRINITY INDUSTRIES, INC & CERTAIN AFFILIATES [EIN = 750225040]
• HEALTH CARE SPENDING ACCOUNT [EIN = 360947870]
• HEALTH CARE PLAN [EIN = 251578904]
• HEALTH CARE PLAN [EIN = 232902931]
• HEALTH CARE PLAN - MICHIGAN HMOS [EIN = 133386776]
• HEALTH CARE PLAN - BLUE CROSS [EIN = 133386776]
• HEALTH CARE CONNECTIONS 401K PLAN [EIN = 562212522]
• HEALTH CARE LEGAL CONCULTING INC DEFINED BENEFIT PENSION PLAN [EIN = 330414164]
• HEALTH CARE SERVICE CORP.; BLUE CROSS BLUE SHIELD; MEDICAL INSURANCE; BLUE BALANCE; EIN #36-1236610 [EIN = 043675131]
• HEALTH CARE PHARMACY RETIREMENT PLAN [EIN = 464363453]
• HEALTH CARE PRACTICE MANAGEMENT, INC. CASH BALANCE PLAN [EIN = 510340618]
• HEALTH CARE BILLING CORP 401(K) PROFIT SHARING PLAN & TRUST [EIN = 061530070]
• HEALTH CARE ACCESS NOW 401(K) PLAN [EIN = 264042151]
• HEALTH CAREER INSTITUTE [EIN = 383905312]
• HEALTH CARE ADVISORY GROUP INC 401(K) PROFIT SHARING PLAN & TRUST [EIN = 452624640]
• HEALTH CARE TRANSFORMATION TASK FORCE 403(B) [EIN = 611765045]
• HEALTH CARE PROVIDERS SOCA BENEFIT PLAN [EIN = 341708405]
• HEALTH CARE PLAN OF MCGEE BROTHERS COMPANY, INC. [EIN = 561146621]
• HEALTH CARE MANAGEMENT SYSTEMS, INC. DENTAL PLAN [EIN = 431342874]
• HEALTH CARE MANAGEMENT SYSTEMS, INC. HEALTH AND WELFARE PLAN [EIN = 431342874]
• HEALTH CARE MANAGEMENT SYSTEMS, INC. VISION PLAN [EIN = 431342874]
• HEALTH CARE MANAGEMENT & STAFFING CORP 401(K) PLAN [EIN = 462764126]
• HEALTH CARE COALITION OF SOUTHERN OREGON 403(B) PLAN [EIN = 931065133]
• HEALTH CARE FOUNDATIONS 401(K) PLAN [EIN = 850515840]
• HEALTH CARE COLLABORATIVE OF RURAL MISSOURI [EIN = 300349211]
• HEALTH CARE RESOURCES PLUS INC [EIN = 810776865]
• HEALTH CARE MEDICAL ASSOCIATES, P.C. 401(K) PLAN [EIN = 472622111]
• HEALTH CARE PHARMACY 401K [EIN = 223833297]
• HEALTH CARE MANAGEMENT, INC. MCF BENEFIT PLAN [EIN = 431703999]
• HEALTH CARE PARTNERS MEDICAL GROUP (COATS), LTD. LIFE AND HEALTH BENEFIT PLAN [EIN = 880213519]
• HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA SOFTWARE, LLC [EIN = 261539542]
• HEALTH CARE TRANSFORMATION 401(K) PLAN [EIN = 852091202]
• HEALTH CARE CONSULTING, INC. 401K PLAN [EIN = 510654858]