BOARD OF TRUSTEES, CAL NECA has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022 : CAL NECA HEALTH TRUST 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-07-31 | $485,065 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-07-31 | $507,964 |
| Total income from all sources (including contributions) | 2022-07-31 | $6,285,247 |
| Total loss/gain on sale of assets | 2022-07-31 | $0 |
| Total of all expenses incurred | 2022-07-31 | $6,074,943 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-07-31 | $5,998,573 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-07-31 | $6,285,184 |
| Value of total assets at end of year | 2022-07-31 | $1,444,810 |
| Value of total assets at beginning of year | 2022-07-31 | $1,257,405 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-07-31 | $76,370 |
| Total interest from all sources | 2022-07-31 | $63 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-07-31 | No |
| Administrative expenses professional fees incurred | 2022-07-31 | $18,330 |
| Was this plan covered by a fidelity bond | 2022-07-31 | Yes |
| Value of fidelity bond cover | 2022-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-07-31 | No |
| Contributions received from participants | 2022-07-31 | $329,931 |
| Assets. Other investments not covered elsewhere at end of year | 2022-07-31 | $2,924 |
| Assets. Other investments not covered elsewhere at beginning of year | 2022-07-31 | $3,453 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-07-31 | $485,065 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-07-31 | $507,964 |
| Administrative expenses (other) incurred | 2022-07-31 | $13,513 |
| Total non interest bearing cash at end of year | 2022-07-31 | $1,297,958 |
| Total non interest bearing cash at beginning of year | 2022-07-31 | $1,021,673 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-07-31 | No |
| Value of net income/loss | 2022-07-31 | $210,304 |
| Value of net assets at end of year (total assets less liabilities) | 2022-07-31 | $959,745 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-07-31 | $749,441 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-07-31 | No |
| Investment advisory and management fees | 2022-07-31 | $70 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-07-31 | $143,928 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-07-31 | $232,279 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-07-31 | $232,279 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-07-31 | $63 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-07-31 | $5,962,190 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-07-31 | No |
| Contributions received in cash from employer | 2022-07-31 | $5,955,253 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-07-31 | $36,383 |
| Contract administrator fees | 2022-07-31 | $44,457 |
| Did the plan have assets held for investment | 2022-07-31 | 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 | 2022-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-07-31 | Unqualified |
| Accountancy firm name | 2022-07-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2022-07-31 | 562552172 |
| 2021 : CAL NECA HEALTH TRUST 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-07-31 | $507,964 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-07-31 | $500,686 |
| Total income from all sources (including contributions) | 2021-07-31 | $6,145,061 |
| Total loss/gain on sale of assets | 2021-07-31 | $0 |
| Total of all expenses incurred | 2021-07-31 | $6,162,603 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-07-31 | $6,090,386 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-07-31 | $6,145,028 |
| Value of total assets at end of year | 2021-07-31 | $1,257,405 |
| Value of total assets at beginning of year | 2021-07-31 | $1,267,669 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-07-31 | $72,217 |
| Total interest from all sources | 2021-07-31 | $33 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-07-31 | No |
| Administrative expenses professional fees incurred | 2021-07-31 | $16,825 |
| Was this plan covered by a fidelity bond | 2021-07-31 | Yes |
| Value of fidelity bond cover | 2021-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-07-31 | No |
| Contributions received from participants | 2021-07-31 | $380,116 |
| Assets. Other investments not covered elsewhere at end of year | 2021-07-31 | $3,453 |
| Assets. Other investments not covered elsewhere at beginning of year | 2021-07-31 | $1,447 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-07-31 | $507,964 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-07-31 | $499,986 |
| Administrative expenses (other) incurred | 2021-07-31 | $10,392 |
| Liabilities. Value of operating payables at beginning of year | 2021-07-31 | $700 |
| Total non interest bearing cash at end of year | 2021-07-31 | $1,021,673 |
| Total non interest bearing cash at beginning of year | 2021-07-31 | $1,142,436 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-07-31 | No |
| Value of net income/loss | 2021-07-31 | $-17,542 |
| Value of net assets at end of year (total assets less liabilities) | 2021-07-31 | $749,441 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-07-31 | $766,983 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-07-31 | No |
| Investment advisory and management fees | 2021-07-31 | $70 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-07-31 | $232,279 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-07-31 | $123,786 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-07-31 | $123,786 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-07-31 | $33 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-07-31 | $6,052,693 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-07-31 | No |
| Contributions received in cash from employer | 2021-07-31 | $5,764,912 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-07-31 | $37,693 |
| Contract administrator fees | 2021-07-31 | $44,930 |
| Did the plan have assets held for investment | 2021-07-31 | 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 | 2021-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-07-31 | Unqualified |
| Accountancy firm name | 2021-07-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2021-07-31 | 562552172 |
| 2020 : CAL NECA HEALTH TRUST 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-07-31 | $500,686 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-07-31 | $496,293 |
| Total income from all sources (including contributions) | 2020-07-31 | $6,229,851 |
| Total loss/gain on sale of assets | 2020-07-31 | $0 |
| Total of all expenses incurred | 2020-07-31 | $6,192,857 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-07-31 | $6,119,898 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-07-31 | $6,226,990 |
| Value of total assets at end of year | 2020-07-31 | $1,267,669 |
| Value of total assets at beginning of year | 2020-07-31 | $1,226,282 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-07-31 | $72,959 |
| Total interest from all sources | 2020-07-31 | $2,861 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-07-31 | No |
| Administrative expenses professional fees incurred | 2020-07-31 | $13,929 |
| Was this plan covered by a fidelity bond | 2020-07-31 | Yes |
| Value of fidelity bond cover | 2020-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-07-31 | No |
| Contributions received from participants | 2020-07-31 | $328,751 |
| Assets. Other investments not covered elsewhere at end of year | 2020-07-31 | $1,447 |
| Assets. Other investments not covered elsewhere at beginning of year | 2020-07-31 | $1,808 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-07-31 | $499,986 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-07-31 | $496,293 |
| Administrative expenses (other) incurred | 2020-07-31 | $11,491 |
| Liabilities. Value of operating payables at end of year | 2020-07-31 | $700 |
| Total non interest bearing cash at end of year | 2020-07-31 | $1,142,436 |
| Total non interest bearing cash at beginning of year | 2020-07-31 | $1,103,549 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-07-31 | No |
| Value of net income/loss | 2020-07-31 | $36,994 |
| Value of net assets at end of year (total assets less liabilities) | 2020-07-31 | $766,983 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-07-31 | $729,989 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-07-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-07-31 | $123,786 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-07-31 | $120,925 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-07-31 | $120,925 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-07-31 | $2,861 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-07-31 | $6,092,624 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-07-31 | No |
| Contributions received in cash from employer | 2020-07-31 | $5,898,239 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-07-31 | $27,274 |
| Contract administrator fees | 2020-07-31 | $47,539 |
| Did the plan have assets held for investment | 2020-07-31 | 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 | 2020-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-07-31 | Unqualified |
| Accountancy firm name | 2020-07-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2020-07-31 | 562552172 |
| 2019 : CAL NECA HEALTH TRUST 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-07-31 | $496,293 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-07-31 | $463,286 |
| Total income from all sources (including contributions) | 2019-07-31 | $6,010,943 |
| Total loss/gain on sale of assets | 2019-07-31 | $0 |
| Total of all expenses incurred | 2019-07-31 | $5,936,797 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-07-31 | $5,868,413 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-07-31 | $6,010,210 |
| Value of total assets at end of year | 2019-07-31 | $1,226,282 |
| Value of total assets at beginning of year | 2019-07-31 | $1,119,129 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-07-31 | $68,384 |
| Total interest from all sources | 2019-07-31 | $733 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-07-31 | No |
| Administrative expenses professional fees incurred | 2019-07-31 | $10,730 |
| Was this plan covered by a fidelity bond | 2019-07-31 | Yes |
| Value of fidelity bond cover | 2019-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-07-31 | No |
| Contributions received from participants | 2019-07-31 | $294,439 |
| Assets. Other investments not covered elsewhere at end of year | 2019-07-31 | $1,808 |
| Assets. Other investments not covered elsewhere at beginning of year | 2019-07-31 | $7,205 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-07-31 | $496,293 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-07-31 | $463,286 |
| Administrative expenses (other) incurred | 2019-07-31 | $11,094 |
| Total non interest bearing cash at end of year | 2019-07-31 | $1,103,549 |
| Total non interest bearing cash at beginning of year | 2019-07-31 | $991,733 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-07-31 | No |
| Value of net income/loss | 2019-07-31 | $74,146 |
| Value of net assets at end of year (total assets less liabilities) | 2019-07-31 | $729,989 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-07-31 | $655,843 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-07-31 | No |
| Investment advisory and management fees | 2019-07-31 | $70 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-07-31 | $120,925 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-07-31 | $120,191 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-07-31 | $120,191 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-07-31 | $733 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-07-31 | $5,831,322 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-07-31 | No |
| Contributions received in cash from employer | 2019-07-31 | $5,715,771 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-07-31 | $37,091 |
| Contract administrator fees | 2019-07-31 | $46,490 |
| Did the plan have assets held for investment | 2019-07-31 | 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 | 2019-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-07-31 | Unqualified |
| Accountancy firm name | 2019-07-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2019-07-31 | 562552172 |
| 2018 : CAL NECA HEALTH TRUST 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-07-31 | $0 |
| Total transfer of assets to this plan | 2018-07-31 | $165,938 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-07-31 | $463,286 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-07-31 | $437,828 |
| Total income from all sources (including contributions) | 2018-07-31 | $5,601,897 |
| Total loss/gain on sale of assets | 2018-07-31 | $0 |
| Total of all expenses incurred | 2018-07-31 | $5,539,735 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-07-31 | $5,469,838 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-07-31 | $5,601,533 |
| Value of total assets at end of year | 2018-07-31 | $1,119,129 |
| Value of total assets at beginning of year | 2018-07-31 | $865,571 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-07-31 | $69,897 |
| Total interest from all sources | 2018-07-31 | $364 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-07-31 | No |
| Administrative expenses professional fees incurred | 2018-07-31 | $11,235 |
| Was this plan covered by a fidelity bond | 2018-07-31 | Yes |
| Value of fidelity bond cover | 2018-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-07-31 | No |
| Contributions received from participants | 2018-07-31 | $282,749 |
| Assets. Other investments not covered elsewhere at end of year | 2018-07-31 | $7,205 |
| Assets. Other investments not covered elsewhere at beginning of year | 2018-07-31 | $6,349 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-07-31 | $463,286 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-07-31 | $437,828 |
| Administrative expenses (other) incurred | 2018-07-31 | $18,890 |
| Total non interest bearing cash at end of year | 2018-07-31 | $991,733 |
| Total non interest bearing cash at beginning of year | 2018-07-31 | $739,395 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-07-31 | No |
| Value of net income/loss | 2018-07-31 | $62,162 |
| Value of net assets at end of year (total assets less liabilities) | 2018-07-31 | $655,843 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-07-31 | $427,743 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-07-31 | No |
| Investment advisory and management fees | 2018-07-31 | $70 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-07-31 | $120,191 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-07-31 | $119,827 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-07-31 | $119,827 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-07-31 | $364 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-07-31 | $5,425,671 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-07-31 | No |
| Contributions received in cash from employer | 2018-07-31 | $5,318,784 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-07-31 | $44,167 |
| Contract administrator fees | 2018-07-31 | $39,702 |
| Did the plan have assets held for investment | 2018-07-31 | 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 | 2018-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-07-31 | Unqualified |
| Accountancy firm name | 2018-07-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2018-07-31 | 562552172 |
| 2017 : CAL NECA HEALTH TRUST 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-07-31 | $437,828 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-07-31 | $434,389 |
| Total income from all sources (including contributions) | 2017-07-31 | $5,334,009 |
| Total loss/gain on sale of assets | 2017-07-31 | $0 |
| Total of all expenses incurred | 2017-07-31 | $5,230,399 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-07-31 | $5,161,717 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-07-31 | $5,333,802 |
| Value of total assets at end of year | 2017-07-31 | $865,571 |
| Value of total assets at beginning of year | 2017-07-31 | $758,523 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-07-31 | $68,682 |
| Total interest from all sources | 2017-07-31 | $207 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-07-31 | No |
| Administrative expenses professional fees incurred | 2017-07-31 | $17,048 |
| Was this plan covered by a fidelity bond | 2017-07-31 | Yes |
| Value of fidelity bond cover | 2017-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-07-31 | No |
| Contributions received from participants | 2017-07-31 | $254,279 |
| Assets. Other investments not covered elsewhere at end of year | 2017-07-31 | $6,349 |
| Assets. Other investments not covered elsewhere at beginning of year | 2017-07-31 | $9,935 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-07-31 | $58,750 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-07-31 | $437,828 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-07-31 | $434,389 |
| Administrative expenses (other) incurred | 2017-07-31 | $14,318 |
| Total non interest bearing cash at end of year | 2017-07-31 | $739,395 |
| Total non interest bearing cash at beginning of year | 2017-07-31 | $1 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-07-31 | No |
| Value of net income/loss | 2017-07-31 | $103,610 |
| Value of net assets at end of year (total assets less liabilities) | 2017-07-31 | $427,743 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-07-31 | $324,134 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-07-31 | No |
| Investment advisory and management fees | 2017-07-31 | $50 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-07-31 | $119,827 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-07-31 | $716,929 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-07-31 | $716,929 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-07-31 | $207 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-07-31 | $5,102,967 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-07-31 | No |
| Contributions received in cash from employer | 2017-07-31 | $5,079,523 |
| Employer contributions (assets) at beginning of year | 2017-07-31 | $31,658 |
| Contract administrator fees | 2017-07-31 | $37,266 |
| Did the plan have assets held for investment | 2017-07-31 | 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 | 2017-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-07-31 | Unqualified |
| Accountancy firm name | 2017-07-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2017-07-31 | 562552172 |
| 2016 : CAL NECA HEALTH TRUST 2016 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2016-07-31 | $-144 |
| Total unrealized appreciation/depreciation of assets | 2016-07-31 | $-144 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-07-31 | $434,389 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-07-31 | $446,460 |
| Total income from all sources (including contributions) | 2016-07-31 | $5,357,395 |
| Total of all expenses incurred | 2016-07-31 | $5,245,941 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-07-31 | $5,178,714 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-07-31 | $5,357,355 |
| Value of total assets at end of year | 2016-07-31 | $758,523 |
| Value of total assets at beginning of year | 2016-07-31 | $659,140 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-07-31 | $67,227 |
| Total interest from all sources | 2016-07-31 | $184 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-07-31 | No |
| Administrative expenses professional fees incurred | 2016-07-31 | $19,296 |
| Was this plan covered by a fidelity bond | 2016-07-31 | Yes |
| Value of fidelity bond cover | 2016-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-07-31 | No |
| Contributions received from participants | 2016-07-31 | $242,773 |
| Assets. Other investments not covered elsewhere at end of year | 2016-07-31 | $9,935 |
| Assets. Other investments not covered elsewhere at beginning of year | 2016-07-31 | $7,576 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-07-31 | $434,389 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-07-31 | $446,235 |
| Administrative expenses (other) incurred | 2016-07-31 | $13,811 |
| Liabilities. Value of operating payables at beginning of year | 2016-07-31 | $225 |
| Total non interest bearing cash at end of year | 2016-07-31 | $1 |
| Total non interest bearing cash at beginning of year | 2016-07-31 | $1 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-07-31 | No |
| Value of net income/loss | 2016-07-31 | $111,454 |
| Value of net assets at end of year (total assets less liabilities) | 2016-07-31 | $324,134 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-07-31 | $212,680 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-07-31 | No |
| Value of interest in common/collective trusts at end of year | 2016-07-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-07-31 | $716,929 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-07-31 | $639,222 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-07-31 | $639,222 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-07-31 | $184 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-07-31 | $5,178,714 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-07-31 | No |
| Contributions received in cash from employer | 2016-07-31 | $5,114,582 |
| Employer contributions (assets) at end of year | 2016-07-31 | $31,658 |
| Employer contributions (assets) at beginning of year | 2016-07-31 | $12,341 |
| Contract administrator fees | 2016-07-31 | $34,120 |
| Did the plan have assets held for investment | 2016-07-31 | 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 | 2016-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-07-31 | Unqualified |
| Accountancy firm name | 2016-07-31 | DUFFY, KRUSPODIN & COMPANY, LLP |
| Accountancy firm EIN | 2016-07-31 | 954244393 |
| 2015 : CAL NECA HEALTH TRUST 2015 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2015-07-31 | $181 |
| Total unrealized appreciation/depreciation of assets | 2015-07-31 | $181 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-07-31 | $446,460 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-07-31 | $409,912 |
| Total income from all sources (including contributions) | 2015-07-31 | $5,248,039 |
| Total loss/gain on sale of assets | 2015-07-31 | $0 |
| Total of all expenses incurred | 2015-07-31 | $5,254,389 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-07-31 | $5,187,739 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-07-31 | $5,247,788 |
| Value of total assets at end of year | 2015-07-31 | $659,139 |
| Value of total assets at beginning of year | 2015-07-31 | $628,941 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-07-31 | $66,650 |
| Total interest from all sources | 2015-07-31 | $70 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-07-31 | No |
| Administrative expenses professional fees incurred | 2015-07-31 | $14,815 |
| Was this plan covered by a fidelity bond | 2015-07-31 | Yes |
| Value of fidelity bond cover | 2015-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-07-31 | No |
| Contributions received from participants | 2015-07-31 | $249,882 |
| Assets. Other investments not covered elsewhere at end of year | 2015-07-31 | $7,576 |
| Assets. Other investments not covered elsewhere at beginning of year | 2015-07-31 | $6,175 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-07-31 | $185 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-07-31 | $446,235 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-07-31 | $5,167 |
| Administrative expenses (other) incurred | 2015-07-31 | $11,969 |
| Liabilities. Value of operating payables at end of year | 2015-07-31 | $225 |
| Liabilities. Value of operating payables at beginning of year | 2015-07-31 | $741 |
| Total non interest bearing cash at end of year | 2015-07-31 | $1 |
| Total non interest bearing cash at beginning of year | 2015-07-31 | $1 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-07-31 | No |
| Value of net income/loss | 2015-07-31 | $-6,350 |
| Value of net assets at end of year (total assets less liabilities) | 2015-07-31 | $212,679 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-07-31 | $219,029 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-07-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-07-31 | $639,221 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-07-31 | $622,580 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-07-31 | $622,580 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-07-31 | $70 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-07-31 | No |
| Contributions received in cash from employer | 2015-07-31 | $4,997,906 |
| Employer contributions (assets) at end of year | 2015-07-31 | $12,341 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-07-31 | $5,187,739 |
| Contract administrator fees | 2015-07-31 | $39,866 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-07-31 | $404,004 |
| Did the plan have assets held for investment | 2015-07-31 | 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 | 2015-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-07-31 | Unqualified |
| Accountancy firm name | 2015-07-31 | DUFFY, KRUSPODIN & COMPANY, LLP |
| Accountancy firm EIN | 2015-07-31 | 954244393 |
| 2014 : CAL NECA HEALTH TRUST 2014 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2014-07-31 | $281 |
| Total unrealized appreciation/depreciation of assets | 2014-07-31 | $281 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-07-31 | $409,912 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-07-31 | $396,085 |
| Total income from all sources (including contributions) | 2014-07-31 | $4,638,105 |
| Total of all expenses incurred | 2014-07-31 | $5,006,397 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-07-31 | $4,939,140 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-07-31 | $4,636,112 |
| Value of total assets at end of year | 2014-07-31 | $628,941 |
| Value of total assets at beginning of year | 2014-07-31 | $983,406 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-07-31 | $67,257 |
| Total interest from all sources | 2014-07-31 | $1,712 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-07-31 | No |
| Administrative expenses professional fees incurred | 2014-07-31 | $16,125 |
| Was this plan covered by a fidelity bond | 2014-07-31 | Yes |
| Value of fidelity bond cover | 2014-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-07-31 | No |
| Contributions received from participants | 2014-07-31 | $213,841 |
| Assets. Other investments not covered elsewhere at end of year | 2014-07-31 | $6,175 |
| Assets. Other investments not covered elsewhere at beginning of year | 2014-07-31 | $6,351 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-07-31 | $185 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-07-31 | $6,911 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-07-31 | $5,167 |
| Administrative expenses (other) incurred | 2014-07-31 | $12,430 |
| Liabilities. Value of operating payables at end of year | 2014-07-31 | $741 |
| Liabilities. Value of operating payables at beginning of year | 2014-07-31 | $457 |
| Total non interest bearing cash at end of year | 2014-07-31 | $1 |
| Total non interest bearing cash at beginning of year | 2014-07-31 | $100 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-07-31 | No |
| Value of net income/loss | 2014-07-31 | $-368,292 |
| Value of net assets at end of year (total assets less liabilities) | 2014-07-31 | $219,029 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-07-31 | $587,321 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-07-31 | No |
| Value of interest in common/collective trusts at end of year | 2014-07-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-07-31 | $622,580 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-07-31 | $968,673 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-07-31 | $968,673 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-07-31 | $1,712 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-07-31 | $4,939,140 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-07-31 | No |
| Contributions received in cash from employer | 2014-07-31 | $4,422,271 |
| Employer contributions (assets) at beginning of year | 2014-07-31 | $1,371 |
| Contract administrator fees | 2014-07-31 | $38,702 |
| Liabilities. Value of benefit claims payable at end of year | 2014-07-31 | $404,004 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-07-31 | $395,628 |
| Did the plan have assets held for investment | 2014-07-31 | 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 | 2014-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-07-31 | Unqualified |
| Accountancy firm name | 2014-07-31 | DUFFY, KRUSPODIN & COMPANY, LLP |
| Accountancy firm EIN | 2014-07-31 | 954244393 |
| 2013 : CAL NECA HEALTH TRUST 2013 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2013-07-31 | $92 |
| Total unrealized appreciation/depreciation of assets | 2013-07-31 | $92 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-07-31 | $396,085 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-07-31 | $387,147 |
| Total income from all sources (including contributions) | 2013-07-31 | $4,503,790 |
| Total of all expenses incurred | 2013-07-31 | $4,780,506 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-07-31 | $4,679,292 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-07-31 | $4,501,379 |
| Value of total assets at end of year | 2013-07-31 | $983,406 |
| Value of total assets at beginning of year | 2013-07-31 | $1,251,184 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-07-31 | $101,214 |
| Total interest from all sources | 2013-07-31 | $2,319 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-07-31 | No |
| Administrative expenses professional fees incurred | 2013-07-31 | $17,967 |
| Was this plan covered by a fidelity bond | 2013-07-31 | Yes |
| Value of fidelity bond cover | 2013-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-07-31 | No |
| Contributions received from participants | 2013-07-31 | $233,114 |
| Assets. Other investments not covered elsewhere at end of year | 2013-07-31 | $6,351 |
| Assets. Other investments not covered elsewhere at beginning of year | 2013-07-31 | $7,811 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-07-31 | $6,911 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-07-31 | $6,957 |
| Administrative expenses (other) incurred | 2013-07-31 | $44,134 |
| Liabilities. Value of operating payables at end of year | 2013-07-31 | $457 |
| Liabilities. Value of operating payables at beginning of year | 2013-07-31 | $187 |
| Total non interest bearing cash at end of year | 2013-07-31 | $100 |
| Total non interest bearing cash at beginning of year | 2013-07-31 | $25 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-07-31 | No |
| Value of net income/loss | 2013-07-31 | $-276,716 |
| Value of net assets at end of year (total assets less liabilities) | 2013-07-31 | $587,321 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-07-31 | $864,037 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-07-31 | No |
| Value of interest in common/collective trusts at end of year | 2013-07-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-07-31 | $968,673 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-07-31 | $1,230,933 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-07-31 | $1,230,933 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-07-31 | $2,319 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-07-31 | $4,679,292 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-07-31 | No |
| Contributions received in cash from employer | 2013-07-31 | $4,268,265 |
| Employer contributions (assets) at end of year | 2013-07-31 | $1,371 |
| Employer contributions (assets) at beginning of year | 2013-07-31 | $5,458 |
| Contract administrator fees | 2013-07-31 | $39,113 |
| Liabilities. Value of benefit claims payable at end of year | 2013-07-31 | $395,628 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-07-31 | $386,960 |
| Did the plan have assets held for investment | 2013-07-31 | 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 | 2013-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-07-31 | Unqualified |
| Accountancy firm name | 2013-07-31 | DUFFY, KRUSPODIN & COMPANY, LLP |
| Accountancy firm EIN | 2013-07-31 | 954244393 |
| 2011 : CAL NECA HEALTH TRUST 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-07-31 | $173 |
| Total unrealized appreciation/depreciation of assets | 2011-07-31 | $173 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-07-31 | $402,966 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-07-31 | $406,348 |
| Total income from all sources (including contributions) | 2011-07-31 | $4,768,451 |
| Total of all expenses incurred | 2011-07-31 | $4,998,120 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-07-31 | $4,907,898 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-07-31 | $4,764,019 |
| Value of total assets at end of year | 2011-07-31 | $1,291,613 |
| Value of total assets at beginning of year | 2011-07-31 | $1,524,664 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-07-31 | $90,222 |
| Total interest from all sources | 2011-07-31 | $4,259 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-07-31 | No |
| Administrative expenses professional fees incurred | 2011-07-31 | $15,725 |
| Was this plan covered by a fidelity bond | 2011-07-31 | Yes |
| Value of fidelity bond cover | 2011-07-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-07-31 | No |
| Contributions received from participants | 2011-07-31 | $324,630 |
| Assets. Other investments not covered elsewhere at end of year | 2011-07-31 | $7,387 |
| Assets. Other investments not covered elsewhere at beginning of year | 2011-07-31 | $18,351 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-07-31 | $32,981 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-07-31 | $40,260 |
| Administrative expenses (other) incurred | 2011-07-31 | $30,809 |
| Liabilities. Value of operating payables at end of year | 2011-07-31 | $275 |
| Liabilities. Value of operating payables at beginning of year | 2011-07-31 | $448 |
| Total non interest bearing cash at end of year | 2011-07-31 | $350 |
| Total non interest bearing cash at beginning of year | 2011-07-31 | $100 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-07-31 | No |
| Value of net income/loss | 2011-07-31 | $-229,669 |
| Value of net assets at end of year (total assets less liabilities) | 2011-07-31 | $888,647 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-07-31 | $1,118,316 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-07-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-07-31 | $1,243,142 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-07-31 | $1,447,705 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-07-31 | $1,447,705 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-07-31 | $4,259 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-07-31 | $4,907,898 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-07-31 | No |
| Contributions received in cash from employer | 2011-07-31 | $4,439,389 |
| Employer contributions (assets) at end of year | 2011-07-31 | $7,753 |
| Employer contributions (assets) at beginning of year | 2011-07-31 | $18,248 |
| Contract administrator fees | 2011-07-31 | $43,688 |
| Liabilities. Value of benefit claims payable at end of year | 2011-07-31 | $402,691 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-07-31 | $405,900 |
| Did the plan have assets held for investment | 2011-07-31 | 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 | 2011-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-07-31 | Unqualified |
| Accountancy firm name | 2011-07-31 | JUDITH O. SIMON, CPA |
| Accountancy firm EIN | 2011-07-31 | 954244393 |
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0002325 |
| Policy instance | 1 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 265 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $321 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $292 | | Insurance broker organization code? | 4 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 12286188 |
| Policy instance | 6 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $1,187 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,764 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,187 | | Insurance broker organization code? | 4 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 103717 |
| Policy instance | 5 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $19,032 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $919,477 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,032 | | Insurance broker organization code? | 4 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8161 |
| Policy instance | 4 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $42,288 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,016,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,288 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00805 |
| Policy instance | 3 |
| Insurance contract or identification number | 00805 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | 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 | W0002325 |
| Policy instance | 2 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $68,931 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,688,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 44283 | | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | | Insurance broker organization code? | 4 |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0002325 |
| Policy instance | 1 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $387 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $387 | | Insurance broker organization code? | 4 |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002325 |
| Policy instance | 2 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $82,283 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,919,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 82283 | | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00805 |
| Policy instance | 3 |
| Insurance contract or identification number | 00805 | | Number of Individuals Covered | 535 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | 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 | 8161 |
| Policy instance | 4 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,975,545 | | 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 | 12286188 |
| Policy instance | 6 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $1,177 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,177 | | Insurance broker organization code? | 4 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 103717 |
| Policy instance | 5 |
| Insurance contract or identification number | 103717 | | 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 $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $762,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0002325 |
| Policy instance | 1 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $-162 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $-162 | | Insurance broker organization code? | 4 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 12286188 |
| Policy instance | 6 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $1,214 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $701 | | Insurance broker organization code? | 4 |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002325 |
| Policy instance | 2 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $48,688 | | Total amount of fees paid to insurance company | USD $66,061 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,577,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,688 | | Insurance broker organization code? | 4 | | Amount paid for insurance broker fees | 66061 | | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00805 |
| Policy instance | 3 |
| Insurance contract or identification number | 00805 | | Number of Individuals Covered | 552 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | 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 | 8161 |
| Policy instance | 4 |
| Insurance contract or identification number | 8161 | | 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 $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,801,786 | | 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 | 103717 |
| Policy instance | 5 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $595,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0002325 |
| Policy instance | 1 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,080 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,080 | | Insurance broker organization code? | 4 |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002325 |
| Policy instance | 2 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 271 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $69,267 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,770,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,267 | | Insurance broker organization code? | 4 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8161 |
| Policy instance | 4 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,803,977 | | 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 | 00805 |
| Policy instance | 3 |
| Insurance contract or identification number | 00805 | | Number of Individuals Covered | 572 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | 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 | 103717 |
| Policy instance | 5 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $602,762 | | 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 | 12286188 |
| Policy instance | 6 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $1,202 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,447 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,202 | | Insurance broker organization code? | 4 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 12286188 |
| Policy instance | 6 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $1,218 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,153 | | 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 | 103717 |
| Policy instance | 5 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $529,374 | | 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 | 8161 |
| Policy instance | 4 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,542,709 | | 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 | 00805 |
| Policy instance | 3 |
| Insurance contract or identification number | 00805 | | Number of Individuals Covered | 604 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | 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 | W0002325 |
| Policy instance | 2 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $72,156 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,886,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0002325 |
| Policy instance | 1 |
| Insurance contract or identification number | W0002325 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $328 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,111 | | 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 | 8161 |
| Policy instance | 2 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,144,250 | | 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 | 0805-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 0805-0000 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $381,388 | | 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 | 12286188 |
| Policy instance | 4 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of fees paid to insurance company | USD $1,185 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1185 | | Insurance broker organization code? | 4 | | Insurance broker name | INOVATIVE COST MGMT SVCS., INC. |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | 975852 |
| Policy instance | 5 |
| Insurance contract or identification number | 975852 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,270 | | 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 | 960335 |
| Policy instance | 6 |
| Insurance contract or identification number | 960335 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,895,820 | | 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 | 103717 |
| Policy instance | 1 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $664,429 | | 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 | 103717 |
| Policy instance | 1 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $711,321 | | 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 | 8161 |
| Policy instance | 2 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $998,422 | | 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 | 0805-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 0805-0000 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $379,350 | | 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 | 12286188 |
| Policy instance | 4 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $1,168 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,168 | | Insurance broker organization code? | 4 | | Insurance broker name | INOVATIVE COST MGMT SVCS, INC. |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | 975852 |
| Policy instance | 5 |
| Insurance contract or identification number | 975852 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,071 | | 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 | 960335 |
| Policy instance | 6 |
| Insurance contract or identification number | 960335 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,776,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | 975852 |
| Policy instance | 2 |
| Insurance contract or identification number | 975852 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $97 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,071 | | 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 | | Insurance broker organization code? | 4 | | Insurance broker name | INNOVATIVE COST MGMT SVCS, INC. |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | 960335 |
| Policy instance | 1 |
| Insurance contract or identification number | 960335 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $32,275 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,417,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,275 | | Insurance broker organization code? | 4 | | Insurance broker name | INOVATIVE COST MGMT SVCS, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 12286188 |
| Policy instance | 3 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $969 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $969 | | Insurance broker organization code? | 4 | | Insurance broker name | INOVATIVE COST MGMT SVCS, INC. |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 0805-0000 |
| Policy instance | 4 |
| Insurance contract or identification number | 0805-0000 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $380,922 | | 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 | 8161 |
| Policy instance | 5 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $929,850 | | 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 | 103717 |
| Policy instance | 6 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $792,804 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | 975852 |
| Policy instance | 2 |
| Insurance contract or identification number | 975852 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,628 | | 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 | 0805-0000 |
| Policy instance | 4 |
| Insurance contract or identification number | 0805-0000 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Dental Insurance Welfare Benefit | Yes | | 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 | 12286188 |
| Policy instance | 3 |
| Insurance contract or identification number | 12286188 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $1,049 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,408 | | 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 | 8161 |
| Policy instance | 5 |
| Insurance contract or identification number | 8161 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $881,155 | | 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 | 103717 |
| Policy instance | 6 |
| Insurance contract or identification number | 103717 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $578,926 | | 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 | 960335 |
| Policy instance | 1 |
| Insurance contract or identification number | 960335 | | Number of Individuals Covered | 382 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of fees paid to insurance company | USD $74 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,806,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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