BOARD OF TRUSTEES, LABOR ALLIANCE MANAGED TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LABOR ALLIANCE MANAGED TRUST FUND
| Measure | Date | Value |
|---|
| 2023 : LABOR ALLIANCE MANAGED TRUST FUND 2023 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2023-03-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-03-31 | $214,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-03-31 | $93,000 |
| Total income from all sources (including contributions) | 2023-03-31 | $208,025,005 |
| Total loss/gain on sale of assets | 2023-03-31 | $0 |
| Total of all expenses incurred | 2023-03-31 | $194,945,984 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-03-31 | $190,255,248 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-03-31 | $208,867,270 |
| Value of total assets at end of year | 2023-03-31 | $64,549,546 |
| Value of total assets at beginning of year | 2023-03-31 | $51,349,525 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-03-31 | $4,690,736 |
| Total interest from all sources | 2023-03-31 | $69,591 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-03-31 | $1,077,239 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2023-03-31 | $1,077,239 |
| Administrative expenses professional fees incurred | 2023-03-31 | $572,253 |
| Was this plan covered by a fidelity bond | 2023-03-31 | Yes |
| Value of fidelity bond cover | 2023-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2023-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-03-31 | No |
| Contributions received from participants | 2023-03-31 | $2,619,770 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-03-31 | $132,675 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-03-31 | $214,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-03-31 | $93,000 |
| Other income not declared elsewhere | 2023-03-31 | $390,927 |
| Administrative expenses (other) incurred | 2023-03-31 | $478,647 |
| Total non interest bearing cash at end of year | 2023-03-31 | $1,776,847 |
| Total non interest bearing cash at beginning of year | 2023-03-31 | $3,829,647 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-03-31 | No |
| Value of net income/loss | 2023-03-31 | $13,079,021 |
| Value of net assets at end of year (total assets less liabilities) | 2023-03-31 | $64,335,546 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-03-31 | $51,256,525 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-03-31 | No |
| Investment advisory and management fees | 2023-03-31 | $69,919 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-03-31 | $38,755,971 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-03-31 | $31,655,828 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-03-31 | $4,301,046 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-03-31 | $1,115,113 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-03-31 | $1,115,113 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-03-31 | $69,591 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-03-31 | $189,876,935 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-03-31 | $-2,380,022 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-03-31 | No |
| Contributions received in cash from employer | 2023-03-31 | $206,247,500 |
| Employer contributions (assets) at end of year | 2023-03-31 | $19,715,682 |
| Employer contributions (assets) at beginning of year | 2023-03-31 | $14,616,262 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-03-31 | $378,313 |
| Contract administrator fees | 2023-03-31 | $3,569,917 |
| Did the plan have assets held for investment | 2023-03-31 | 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 | 2023-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-03-31 | Unqualified |
| Accountancy firm name | 2023-03-31 | WITHUMSMITH+BROWN, PC |
| Accountancy firm EIN | 2023-03-31 | 222027092 |
| 2022 : LABOR ALLIANCE MANAGED TRUST FUND 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-03-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-03-31 | $93,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-03-31 | $78,000 |
| Total income from all sources (including contributions) | 2022-03-31 | $180,637,226 |
| Total loss/gain on sale of assets | 2022-03-31 | $0 |
| Total of all expenses incurred | 2022-03-31 | $174,752,814 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-03-31 | $170,822,295 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-03-31 | $180,741,767 |
| Value of total assets at end of year | 2022-03-31 | $51,349,525 |
| Value of total assets at beginning of year | 2022-03-31 | $45,450,113 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-03-31 | $3,930,519 |
| Total interest from all sources | 2022-03-31 | $321 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-03-31 | $893,942 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-03-31 | $893,942 |
| Administrative expenses professional fees incurred | 2022-03-31 | $446,335 |
| Was this plan covered by a fidelity bond | 2022-03-31 | Yes |
| Value of fidelity bond cover | 2022-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-03-31 | No |
| Contributions received from participants | 2022-03-31 | $2,968,371 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-03-31 | $132,675 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-03-31 | $93,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-03-31 | $78,000 |
| Other income not declared elsewhere | 2022-03-31 | $78,462 |
| Administrative expenses (other) incurred | 2022-03-31 | $423,994 |
| Total non interest bearing cash at end of year | 2022-03-31 | $3,829,647 |
| Total non interest bearing cash at beginning of year | 2022-03-31 | $1,711,471 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-03-31 | No |
| Value of net income/loss | 2022-03-31 | $5,884,412 |
| Value of net assets at end of year (total assets less liabilities) | 2022-03-31 | $51,256,525 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-03-31 | $45,372,113 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-03-31 | No |
| Investment advisory and management fees | 2022-03-31 | $63,387 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-03-31 | $31,655,828 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-03-31 | $28,546,902 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-03-31 | $1,115,113 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-03-31 | $1,477,868 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-03-31 | $1,477,868 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-03-31 | $321 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-03-31 | $170,489,254 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-03-31 | $-1,077,266 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-03-31 | No |
| Contributions received in cash from employer | 2022-03-31 | $177,773,396 |
| Employer contributions (assets) at end of year | 2022-03-31 | $14,616,262 |
| Employer contributions (assets) at beginning of year | 2022-03-31 | $13,713,872 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-03-31 | $333,041 |
| Contract administrator fees | 2022-03-31 | $2,996,803 |
| Did the plan have assets held for investment | 2022-03-31 | 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 | 2022-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-03-31 | Unqualified |
| Accountancy firm name | 2022-03-31 | WITHUMSMITH+BROWN, PC |
| Accountancy firm EIN | 2022-03-31 | 222027092 |
| 2021 : LABOR ALLIANCE MANAGED TRUST FUND 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-03-31 | $78,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-03-31 | $42,000 |
| Total income from all sources (including contributions) | 2021-03-31 | $167,319,106 |
| Total of all expenses incurred | 2021-03-31 | $162,034,121 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-03-31 | $158,517,476 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-03-31 | $163,940,026 |
| Value of total assets at end of year | 2021-03-31 | $45,450,113 |
| Value of total assets at beginning of year | 2021-03-31 | $40,129,128 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-03-31 | $3,516,645 |
| Total interest from all sources | 2021-03-31 | $3,700 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-03-31 | $542,836 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-03-31 | $542,836 |
| Administrative expenses professional fees incurred | 2021-03-31 | $290,384 |
| Was this plan covered by a fidelity bond | 2021-03-31 | Yes |
| Value of fidelity bond cover | 2021-03-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-03-31 | No |
| Contributions received from participants | 2021-03-31 | $2,390,155 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-03-31 | $78,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-03-31 | $42,000 |
| Other income not declared elsewhere | 2021-03-31 | $102,832 |
| Administrative expenses (other) incurred | 2021-03-31 | $398,823 |
| Total non interest bearing cash at end of year | 2021-03-31 | $1,711,471 |
| Total non interest bearing cash at beginning of year | 2021-03-31 | $1,927,686 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-03-31 | No |
| Value of net income/loss | 2021-03-31 | $5,284,985 |
| Value of net assets at end of year (total assets less liabilities) | 2021-03-31 | $45,372,113 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-03-31 | $40,087,128 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-03-31 | No |
| Investment advisory and management fees | 2021-03-31 | $69,820 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-03-31 | $28,546,902 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-03-31 | $18,943,629 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-03-31 | $1,477,868 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-03-31 | $5,878,708 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-03-31 | $5,878,708 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-03-31 | $3,700 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-03-31 | $158,240,126 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-03-31 | $2,729,712 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-03-31 | No |
| Contributions received in cash from employer | 2021-03-31 | $161,549,871 |
| Employer contributions (assets) at end of year | 2021-03-31 | $13,713,872 |
| Employer contributions (assets) at beginning of year | 2021-03-31 | $13,379,105 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-03-31 | $277,350 |
| Contract administrator fees | 2021-03-31 | $2,757,618 |
| Did the plan have assets held for investment | 2021-03-31 | 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 | 2021-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-03-31 | Unqualified |
| Accountancy firm name | 2021-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2021-03-31 | 522385296 |
| 2020 : LABOR ALLIANCE MANAGED TRUST FUND 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-03-31 | $42,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-03-31 | $395,000 |
| Total income from all sources (including contributions) | 2020-03-31 | $167,465,476 |
| Total of all expenses incurred | 2020-03-31 | $163,285,358 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-03-31 | $159,800,068 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-03-31 | $166,986,190 |
| Value of total assets at end of year | 2020-03-31 | $40,129,128 |
| Value of total assets at beginning of year | 2020-03-31 | $36,302,010 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-03-31 | $3,485,290 |
| Total interest from all sources | 2020-03-31 | $34,924 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-03-31 | $639,105 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-03-31 | $639,105 |
| Administrative expenses professional fees incurred | 2020-03-31 | $369,738 |
| Was this plan covered by a fidelity bond | 2020-03-31 | Yes |
| Value of fidelity bond cover | 2020-03-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-03-31 | No |
| Contributions received from participants | 2020-03-31 | $2,059,071 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-03-31 | $42,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-03-31 | $395,000 |
| Other income not declared elsewhere | 2020-03-31 | $652,944 |
| Administrative expenses (other) incurred | 2020-03-31 | $384,614 |
| Total non interest bearing cash at end of year | 2020-03-31 | $1,927,686 |
| Total non interest bearing cash at beginning of year | 2020-03-31 | $2,111,881 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-03-31 | No |
| Value of net income/loss | 2020-03-31 | $4,180,118 |
| Value of net assets at end of year (total assets less liabilities) | 2020-03-31 | $40,087,128 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-03-31 | $35,907,010 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-03-31 | No |
| Investment advisory and management fees | 2020-03-31 | $65,410 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-03-31 | $18,943,629 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-03-31 | $15,662,307 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-03-31 | $5,878,708 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-03-31 | $4,420,060 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-03-31 | $4,420,060 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-03-31 | $34,924 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-03-31 | $159,449,230 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-03-31 | $-847,687 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-03-31 | No |
| Contributions received in cash from employer | 2020-03-31 | $164,927,119 |
| Employer contributions (assets) at end of year | 2020-03-31 | $13,379,105 |
| Employer contributions (assets) at beginning of year | 2020-03-31 | $14,107,762 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-03-31 | $350,838 |
| Contract administrator fees | 2020-03-31 | $2,665,528 |
| Did the plan have assets held for investment | 2020-03-31 | 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 | 2020-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-03-31 | Unqualified |
| Accountancy firm name | 2020-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2020-03-31 | 522385296 |
| 2019 : LABOR ALLIANCE MANAGED TRUST FUND 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-03-31 | $395,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-03-31 | $581,832 |
| Total income from all sources (including contributions) | 2019-03-31 | $167,289,399 |
| Total of all expenses incurred | 2019-03-31 | $163,275,486 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-03-31 | $159,774,892 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-03-31 | $166,461,074 |
| Value of total assets at end of year | 2019-03-31 | $36,302,010 |
| Value of total assets at beginning of year | 2019-03-31 | $32,474,929 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-03-31 | $3,500,594 |
| Total interest from all sources | 2019-03-31 | $58,912 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-03-31 | $455,622 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-03-31 | $455,622 |
| Administrative expenses professional fees incurred | 2019-03-31 | $406,195 |
| Was this plan covered by a fidelity bond | 2019-03-31 | Yes |
| Value of fidelity bond cover | 2019-03-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-03-31 | No |
| Contributions received from participants | 2019-03-31 | $2,046,182 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-03-31 | $395,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-03-31 | $581,832 |
| Other income not declared elsewhere | 2019-03-31 | $151,321 |
| Administrative expenses (other) incurred | 2019-03-31 | $366,227 |
| Total non interest bearing cash at end of year | 2019-03-31 | $2,111,881 |
| Total non interest bearing cash at beginning of year | 2019-03-31 | $3,030,205 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-03-31 | No |
| Value of net income/loss | 2019-03-31 | $4,013,913 |
| Value of net assets at end of year (total assets less liabilities) | 2019-03-31 | $35,907,010 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-03-31 | $31,893,097 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-03-31 | No |
| Investment advisory and management fees | 2019-03-31 | $56,995 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-03-31 | $15,662,307 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-03-31 | $7,832,476 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-03-31 | $4,420,060 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-03-31 | $8,141,544 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-03-31 | $8,141,544 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-03-31 | $58,912 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-03-31 | $159,472,124 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-03-31 | $162,470 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-03-31 | No |
| Contributions received in cash from employer | 2019-03-31 | $164,414,892 |
| Employer contributions (assets) at end of year | 2019-03-31 | $14,107,762 |
| Employer contributions (assets) at beginning of year | 2019-03-31 | $13,470,704 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-03-31 | $302,768 |
| Contract administrator fees | 2019-03-31 | $2,671,177 |
| Did the plan have assets held for investment | 2019-03-31 | 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 | 2019-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-03-31 | Unqualified |
| Accountancy firm name | 2019-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2019-03-31 | 522385296 |
| 2018 : LABOR ALLIANCE MANAGED TRUST FUND 2018 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2018-03-31 | $-2,317 |
| Total unrealized appreciation/depreciation of assets | 2018-03-31 | $-2,317 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-03-31 | $581,832 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-03-31 | $47,595 |
| Total income from all sources (including contributions) | 2018-03-31 | $165,475,588 |
| Total of all expenses incurred | 2018-03-31 | $163,290,448 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-03-31 | $159,906,071 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-03-31 | $165,046,074 |
| Value of total assets at end of year | 2018-03-31 | $32,474,929 |
| Value of total assets at beginning of year | 2018-03-31 | $29,755,552 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-03-31 | $3,384,377 |
| Total interest from all sources | 2018-03-31 | $25,194 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-03-31 | $27,014 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-03-31 | $27,014 |
| Administrative expenses professional fees incurred | 2018-03-31 | $355,940 |
| Was this plan covered by a fidelity bond | 2018-03-31 | Yes |
| Value of fidelity bond cover | 2018-03-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-03-31 | No |
| Contributions received from participants | 2018-03-31 | $2,240,540 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-03-31 | $581,832 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-03-31 | $47,595 |
| Other income not declared elsewhere | 2018-03-31 | $74,893 |
| Administrative expenses (other) incurred | 2018-03-31 | $395,690 |
| Total non interest bearing cash at end of year | 2018-03-31 | $3,030,205 |
| Total non interest bearing cash at beginning of year | 2018-03-31 | $3,835,136 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-03-31 | No |
| Value of net income/loss | 2018-03-31 | $2,185,140 |
| Value of net assets at end of year (total assets less liabilities) | 2018-03-31 | $31,893,097 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-03-31 | $29,707,957 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-03-31 | No |
| Investment advisory and management fees | 2018-03-31 | $33,671 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-03-31 | $7,832,476 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-03-31 | $8,141,544 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-03-31 | $1,373,318 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-03-31 | $1,373,318 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-03-31 | $25,194 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2018-03-31 | $11,338,944 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-03-31 | $159,628,884 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-03-31 | $-58,142 |
| Net investment gain or loss from common/collective trusts | 2018-03-31 | $362,872 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-03-31 | No |
| Contributions received in cash from employer | 2018-03-31 | $162,805,534 |
| Employer contributions (assets) at end of year | 2018-03-31 | $13,470,704 |
| Employer contributions (assets) at beginning of year | 2018-03-31 | $13,208,154 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-03-31 | $277,187 |
| Contract administrator fees | 2018-03-31 | $2,599,076 |
| Did the plan have assets held for investment | 2018-03-31 | 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 | 2018-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-03-31 | Unqualified |
| Accountancy firm name | 2018-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2018-03-31 | 522385296 |
| 2017 : LABOR ALLIANCE MANAGED TRUST FUND 2017 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2017-03-31 | $-4,268 |
| Total unrealized appreciation/depreciation of assets | 2017-03-31 | $-4,268 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-03-31 | $47,595 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-03-31 | $39,000 |
| Total income from all sources (including contributions) | 2017-03-31 | $149,140,029 |
| Total of all expenses incurred | 2017-03-31 | $145,684,893 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-03-31 | $142,423,880 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-03-31 | $148,732,051 |
| Value of total assets at end of year | 2017-03-31 | $29,755,552 |
| Value of total assets at beginning of year | 2017-03-31 | $26,291,821 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-03-31 | $3,261,013 |
| Total interest from all sources | 2017-03-31 | $31,773 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-03-31 | No |
| Administrative expenses professional fees incurred | 2017-03-31 | $452,736 |
| Was this plan covered by a fidelity bond | 2017-03-31 | Yes |
| Value of fidelity bond cover | 2017-03-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-03-31 | No |
| Contributions received from participants | 2017-03-31 | $1,754,246 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-03-31 | $47,595 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-03-31 | $39,000 |
| Other income not declared elsewhere | 2017-03-31 | $51,414 |
| Administrative expenses (other) incurred | 2017-03-31 | $401,904 |
| Total non interest bearing cash at end of year | 2017-03-31 | $3,835,136 |
| Total non interest bearing cash at beginning of year | 2017-03-31 | $3,340,999 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-03-31 | No |
| Value of net income/loss | 2017-03-31 | $3,455,136 |
| Value of net assets at end of year (total assets less liabilities) | 2017-03-31 | $29,707,957 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-03-31 | $26,252,821 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-03-31 | No |
| Investment advisory and management fees | 2017-03-31 | $30,076 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-03-31 | $1,373,318 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-03-31 | $3,207,369 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-03-31 | $3,207,369 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-03-31 | $31,773 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2017-03-31 | $11,338,944 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2017-03-31 | $9,177,885 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-03-31 | $142,184,788 |
| Net gain/loss from 103.12 investment entities | 2017-03-31 | $329,059 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-03-31 | No |
| Contributions received in cash from employer | 2017-03-31 | $146,977,805 |
| Employer contributions (assets) at end of year | 2017-03-31 | $13,208,154 |
| Employer contributions (assets) at beginning of year | 2017-03-31 | $10,565,568 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-03-31 | $239,092 |
| Contract administrator fees | 2017-03-31 | $2,376,297 |
| Did the plan have assets held for investment | 2017-03-31 | 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 | 2017-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-03-31 | Unqualified |
| Accountancy firm name | 2017-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2017-03-31 | 522385296 |
| 2016 : LABOR ALLIANCE MANAGED TRUST FUND 2016 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2016-03-31 | $3,941 |
| Total unrealized appreciation/depreciation of assets | 2016-03-31 | $3,941 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-03-31 | $39,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-03-31 | $77,317 |
| Total income from all sources (including contributions) | 2016-03-31 | $130,110,955 |
| Total of all expenses incurred | 2016-03-31 | $127,348,189 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-03-31 | $124,475,196 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-03-31 | $129,785,708 |
| Value of total assets at end of year | 2016-03-31 | $26,291,821 |
| Value of total assets at beginning of year | 2016-03-31 | $23,567,372 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-03-31 | $2,872,993 |
| Total interest from all sources | 2016-03-31 | $42,002 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-03-31 | No |
| Administrative expenses professional fees incurred | 2016-03-31 | $263,156 |
| Was this plan covered by a fidelity bond | 2016-03-31 | Yes |
| Value of fidelity bond cover | 2016-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-03-31 | No |
| Contributions received from participants | 2016-03-31 | $1,712,939 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-03-31 | $39,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-03-31 | $77,317 |
| Other income not declared elsewhere | 2016-03-31 | $147,918 |
| Administrative expenses (other) incurred | 2016-03-31 | $535,939 |
| Total non interest bearing cash at end of year | 2016-03-31 | $3,340,999 |
| Total non interest bearing cash at beginning of year | 2016-03-31 | $1,499,970 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-03-31 | No |
| Value of net income/loss | 2016-03-31 | $2,762,766 |
| Value of net assets at end of year (total assets less liabilities) | 2016-03-31 | $26,252,821 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-03-31 | $23,490,055 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-03-31 | No |
| Investment advisory and management fees | 2016-03-31 | $19,721 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-03-31 | $3,207,369 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-03-31 | $5,166,903 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-03-31 | $5,166,903 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-03-31 | $42,002 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2016-03-31 | $9,177,885 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2016-03-31 | $7,047,499 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-03-31 | $124,232,731 |
| Net gain/loss from 103.12 investment entities | 2016-03-31 | $131,386 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-03-31 | No |
| Contributions received in cash from employer | 2016-03-31 | $128,072,769 |
| Employer contributions (assets) at end of year | 2016-03-31 | $10,565,568 |
| Employer contributions (assets) at beginning of year | 2016-03-31 | $9,853,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-03-31 | $242,465 |
| Contract administrator fees | 2016-03-31 | $2,054,177 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-03-31 | No |
| Did the plan have assets held for investment | 2016-03-31 | 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 | 2016-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-03-31 | Unqualified |
| Accountancy firm name | 2016-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2016-03-31 | 522385296 |
| 2015 : LABOR ALLIANCE MANAGED TRUST FUND 2015 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2015-03-31 | $8,218 |
| Total unrealized appreciation/depreciation of assets | 2015-03-31 | $8,218 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-03-31 | $77,317 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-03-31 | $139,829 |
| Total income from all sources (including contributions) | 2015-03-31 | $113,921,152 |
| Total of all expenses incurred | 2015-03-31 | $110,616,909 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-03-31 | $108,252,952 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-03-31 | $113,710,174 |
| Value of total assets at end of year | 2015-03-31 | $23,567,372 |
| Value of total assets at beginning of year | 2015-03-31 | $20,325,641 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-03-31 | $2,363,957 |
| Total interest from all sources | 2015-03-31 | $36,089 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-03-31 | No |
| Administrative expenses professional fees incurred | 2015-03-31 | $263,609 |
| Was this plan covered by a fidelity bond | 2015-03-31 | Yes |
| Value of fidelity bond cover | 2015-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-03-31 | No |
| Contributions received from participants | 2015-03-31 | $1,288,410 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-03-31 | $8,487 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-03-31 | $11,185 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-03-31 | $77,317 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-03-31 | $139,829 |
| Other income not declared elsewhere | 2015-03-31 | $119,172 |
| Administrative expenses (other) incurred | 2015-03-31 | $187,306 |
| Total non interest bearing cash at end of year | 2015-03-31 | $1,499,970 |
| Total non interest bearing cash at beginning of year | 2015-03-31 | $7,520,518 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-03-31 | No |
| Value of net income/loss | 2015-03-31 | $3,304,243 |
| Value of net assets at end of year (total assets less liabilities) | 2015-03-31 | $23,490,055 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-03-31 | $20,185,812 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-03-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-03-31 | $5,166,903 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-03-31 | $4,030,938 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-03-31 | $4,030,938 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-03-31 | $36,089 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2015-03-31 | $7,047,499 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-03-31 | $108,244,465 |
| Net gain/loss from 103.12 investment entities | 2015-03-31 | $47,499 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-03-31 | No |
| Contributions received in cash from employer | 2015-03-31 | $112,421,764 |
| Employer contributions (assets) at end of year | 2015-03-31 | $9,853,000 |
| Employer contributions (assets) at beginning of year | 2015-03-31 | $8,763,000 |
| Contract administrator fees | 2015-03-31 | $1,913,042 |
| Did the plan have assets held for investment | 2015-03-31 | 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 | 2015-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-03-31 | Unqualified |
| Accountancy firm name | 2015-03-31 | ROBERT J. RUEHL CPA |
| Accountancy firm EIN | 2015-03-31 | 453030861 |
| 2014 : LABOR ALLIANCE MANAGED TRUST FUND 2014 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2014-03-31 | $-8,218 |
| Total unrealized appreciation/depreciation of assets | 2014-03-31 | $-8,218 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-03-31 | $139,829 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-03-31 | $31,222 |
| Total income from all sources (including contributions) | 2014-03-31 | $107,551,099 |
| Total of all expenses incurred | 2014-03-31 | $105,266,446 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-03-31 | $103,276,126 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-03-31 | $107,474,798 |
| Value of total assets at end of year | 2014-03-31 | $20,325,641 |
| Value of total assets at beginning of year | 2014-03-31 | $17,932,381 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-03-31 | $1,990,320 |
| Total interest from all sources | 2014-03-31 | $17,915 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-03-31 | No |
| Administrative expenses professional fees incurred | 2014-03-31 | $254,428 |
| Was this plan covered by a fidelity bond | 2014-03-31 | Yes |
| Value of fidelity bond cover | 2014-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-03-31 | No |
| Contributions received from participants | 2014-03-31 | $1,440,528 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-03-31 | $11,185 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-03-31 | $139,829 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-03-31 | $31,222 |
| Other income not declared elsewhere | 2014-03-31 | $66,604 |
| Administrative expenses (other) incurred | 2014-03-31 | $117,875 |
| Total non interest bearing cash at end of year | 2014-03-31 | $7,520,518 |
| Total non interest bearing cash at beginning of year | 2014-03-31 | $6,592,140 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-03-31 | No |
| Value of net income/loss | 2014-03-31 | $2,284,653 |
| Value of net assets at end of year (total assets less liabilities) | 2014-03-31 | $20,185,812 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-03-31 | $17,901,159 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-03-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-03-31 | $4,030,938 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-03-31 | $3,021,241 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-03-31 | $3,021,241 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-03-31 | $17,915 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-03-31 | $103,276,126 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-03-31 | No |
| Contributions received in cash from employer | 2014-03-31 | $106,034,270 |
| Employer contributions (assets) at end of year | 2014-03-31 | $8,763,000 |
| Employer contributions (assets) at beginning of year | 2014-03-31 | $8,319,000 |
| Contract administrator fees | 2014-03-31 | $1,618,017 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-03-31 | No |
| Did the plan have assets held for investment | 2014-03-31 | 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 | 2014-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-03-31 | Unqualified |
| Accountancy firm name | 2014-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2014-03-31 | 522385296 |
| 2013 : LABOR ALLIANCE MANAGED TRUST FUND 2013 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2013-03-31 | $-5,978 |
| Total unrealized appreciation/depreciation of assets | 2013-03-31 | $-5,978 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-03-31 | $31,222 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-03-31 | $561,822 |
| Total income from all sources (including contributions) | 2013-03-31 | $103,604,497 |
| Total of all expenses incurred | 2013-03-31 | $100,914,330 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-03-31 | $98,918,424 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-03-31 | $103,505,252 |
| Value of total assets at end of year | 2013-03-31 | $17,932,381 |
| Value of total assets at beginning of year | 2013-03-31 | $15,772,814 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-03-31 | $1,995,906 |
| Total interest from all sources | 2013-03-31 | $14,123 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-03-31 | No |
| Administrative expenses professional fees incurred | 2013-03-31 | $266,409 |
| Was this plan covered by a fidelity bond | 2013-03-31 | Yes |
| Value of fidelity bond cover | 2013-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-03-31 | No |
| Contributions received from participants | 2013-03-31 | $2,582,776 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-03-31 | $31,222 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-03-31 | $561,822 |
| Other income not declared elsewhere | 2013-03-31 | $91,100 |
| Administrative expenses (other) incurred | 2013-03-31 | $99,732 |
| Total non interest bearing cash at end of year | 2013-03-31 | $6,592,140 |
| Total non interest bearing cash at beginning of year | 2013-03-31 | $4,934,498 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-03-31 | No |
| Value of net income/loss | 2013-03-31 | $2,690,167 |
| Value of net assets at end of year (total assets less liabilities) | 2013-03-31 | $17,901,159 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-03-31 | $15,210,992 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-03-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-03-31 | $3,021,241 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-03-31 | $3,261,316 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-03-31 | $3,261,316 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-03-31 | $14,123 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-03-31 | $98,918,424 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-03-31 | No |
| Contributions received in cash from employer | 2013-03-31 | $100,922,476 |
| Employer contributions (assets) at end of year | 2013-03-31 | $8,319,000 |
| Employer contributions (assets) at beginning of year | 2013-03-31 | $7,577,000 |
| Contract administrator fees | 2013-03-31 | $1,629,765 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-03-31 | No |
| Did the plan have assets held for investment | 2013-03-31 | 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 | 2013-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-03-31 | Unqualified |
| Accountancy firm name | 2013-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2013-03-31 | 522385296 |
| 2012 : LABOR ALLIANCE MANAGED TRUST FUND 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2012-03-31 | $9,731 |
| Total unrealized appreciation/depreciation of assets | 2012-03-31 | $9,731 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-03-31 | $561,822 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-03-31 | $528,621 |
| Total income from all sources (including contributions) | 2012-03-31 | $86,859,242 |
| Total of all expenses incurred | 2012-03-31 | $84,934,606 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-03-31 | $83,141,818 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-03-31 | $86,765,673 |
| Value of total assets at end of year | 2012-03-31 | $15,772,814 |
| Value of total assets at beginning of year | 2012-03-31 | $13,814,977 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-03-31 | $1,792,788 |
| Total interest from all sources | 2012-03-31 | $6,182 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-03-31 | No |
| Administrative expenses professional fees incurred | 2012-03-31 | $269,932 |
| Was this plan covered by a fidelity bond | 2012-03-31 | Yes |
| Value of fidelity bond cover | 2012-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-03-31 | No |
| Contributions received from participants | 2012-03-31 | $2,257,404 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-03-31 | $39,352 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-03-31 | $561,822 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-03-31 | $528,621 |
| Other income not declared elsewhere | 2012-03-31 | $77,656 |
| Administrative expenses (other) incurred | 2012-03-31 | $70,553 |
| Total non interest bearing cash at end of year | 2012-03-31 | $4,934,498 |
| Total non interest bearing cash at beginning of year | 2012-03-31 | $14,928 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-03-31 | No |
| Value of net income/loss | 2012-03-31 | $1,924,636 |
| Value of net assets at end of year (total assets less liabilities) | 2012-03-31 | $15,210,992 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-03-31 | $13,286,356 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-03-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-03-31 | $3,261,316 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-03-31 | $7,710,697 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-03-31 | $7,710,697 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-03-31 | $6,182 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-03-31 | $83,141,818 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-03-31 | No |
| Contributions received in cash from employer | 2012-03-31 | $84,508,269 |
| Employer contributions (assets) at end of year | 2012-03-31 | $7,577,000 |
| Employer contributions (assets) at beginning of year | 2012-03-31 | $6,050,000 |
| Contract administrator fees | 2012-03-31 | $1,452,303 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-03-31 | No |
| Did the plan have assets held for investment | 2012-03-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-03-31 | Unqualified |
| Accountancy firm name | 2012-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2012-03-31 | 522385296 |
| 2011 : LABOR ALLIANCE MANAGED TRUST FUND 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-03-31 | $-1,115 |
| Total unrealized appreciation/depreciation of assets | 2011-03-31 | $-1,115 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-03-31 | $528,621 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-03-31 | $361,839 |
| Total income from all sources (including contributions) | 2011-03-31 | $74,682,064 |
| Total of all expenses incurred | 2011-03-31 | $74,423,503 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-03-31 | $72,948,142 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-03-31 | $74,180,841 |
| Value of total assets at end of year | 2011-03-31 | $13,814,977 |
| Value of total assets at beginning of year | 2011-03-31 | $13,389,634 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-03-31 | $1,475,361 |
| Total interest from all sources | 2011-03-31 | $19,679 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-03-31 | $485 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-03-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-03-31 | $485 |
| Administrative expenses professional fees incurred | 2011-03-31 | $252,916 |
| Was this plan covered by a fidelity bond | 2011-03-31 | Yes |
| Value of fidelity bond cover | 2011-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-03-31 | No |
| Contributions received from participants | 2011-03-31 | $2,180,656 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-03-31 | $39,352 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-03-31 | $200,184 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-03-31 | $528,621 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-03-31 | $361,839 |
| Other income not declared elsewhere | 2011-03-31 | $482,174 |
| Administrative expenses (other) incurred | 2011-03-31 | $67,391 |
| Total non interest bearing cash at end of year | 2011-03-31 | $14,928 |
| Total non interest bearing cash at beginning of year | 2011-03-31 | $15,343 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-03-31 | No |
| Value of net income/loss | 2011-03-31 | $258,561 |
| Value of net assets at end of year (total assets less liabilities) | 2011-03-31 | $13,286,356 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-03-31 | $13,027,795 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-03-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-03-31 | $4,690,967 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-03-31 | $7,710,697 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-03-31 | $3,245,140 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-03-31 | $3,245,140 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-03-31 | $19,679 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-03-31 | $72,948,142 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-03-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-03-31 | No |
| Contributions received in cash from employer | 2011-03-31 | $72,000,185 |
| Employer contributions (assets) at end of year | 2011-03-31 | $6,050,000 |
| Employer contributions (assets) at beginning of year | 2011-03-31 | $5,238,000 |
| Contract administrator fees | 2011-03-31 | $1,155,054 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-03-31 | No |
| Did the plan have assets held for investment | 2011-03-31 | 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 | 2011-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-03-31 | Unqualified |
| Accountancy firm name | 2011-03-31 | LINDQUIST LLP |
| Accountancy firm EIN | 2011-03-31 | 522385296 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876 |
| Policy instance | 3 |
| Insurance contract or identification number | 93876 | | Number of Individuals Covered | 12817 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 | 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 | | 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 $289,671 | | 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 | 117786 ET AL. |
| Policy instance | 1 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 20662 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 $139,792,042 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 12754 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,418,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | H2001 |
| Policy instance | 4 |
| Insurance contract or identification number | H2001 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 $667,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393, 394 |
| Policy instance | 5 |
| Insurance contract or identification number | 393, 394 | | Number of Individuals Covered | 575 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 $1,125,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 6 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 13039 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793, 716797 |
| Policy instance | 7 |
| Insurance contract or identification number | 711793, 716797 | | Number of Individuals Covered | 4109 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 $9,997,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 8 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1559 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 | 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 $28,937,308 | | 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 | 12166751 ET AL. |
| Policy instance | 9 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 12990 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | 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 $1,706,369 | | 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 | 602597 |
| Policy instance | 5 |
| Insurance contract or identification number | 602597 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | 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 $1,042,219 | | 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 | 233263 |
| Policy instance | 4 |
| Insurance contract or identification number | 233263 | | Number of Individuals Covered | 1302 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | 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 $6,615,868 | | 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 | 231149 |
| Policy instance | 3 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2687 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | 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 $13,440,466 | | 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 | 117786 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 16977 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | 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 | 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 $101,014,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | H2001 |
| Policy instance | 1 |
| Insurance contract or identification number | H2001 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 $835,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 6 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 10072 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,309,525 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876 |
| Policy instance | 7 |
| Insurance contract or identification number | 93876 | | Number of Individuals Covered | 10059 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 | 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 | | 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 $248,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393, 394 |
| Policy instance | 8 |
| Insurance contract or identification number | 393, 394 | | Number of Individuals Covered | 462 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 $954,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793, 716797 |
| Policy instance | 10 |
| Insurance contract or identification number | 711793, 716797 | | Number of Individuals Covered | 3460 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 $9,396,902 | | 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 | 12166751 ET AL. |
| Policy instance | 12 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 10477 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 | 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 $2,695,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 11 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1490 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 | 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 $29,305,713 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 9 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 10412 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | 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 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 4 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 9465 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $231,573 | | 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 | 117786 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 16977 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,014,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 5 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 10849 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793, 716797 |
| Policy instance | 6 |
| Insurance contract or identification number | 711793, 716797 | | Number of Individuals Covered | 3200 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,962,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 1 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1614 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $27,850,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 7 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 9153 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,229,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231149 |
| Policy instance | 8 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2797 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,237,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393 & 394 |
| Policy instance | 9 |
| Insurance contract or identification number | 393 & 394 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $863,610 | | 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 | 12166751 ET AL. |
| Policy instance | 3 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 9842 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,511,563 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | H2001 |
| Policy instance | 10 |
| Insurance contract or identification number | H2001 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $961,129 | | 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 | 602597 |
| Policy instance | 12 |
| Insurance contract or identification number | 602597 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,042,219 | | 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 | 233263 |
| Policy instance | 11 |
| Insurance contract or identification number | 233263 | | Number of Individuals Covered | 1302 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,615,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 1 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1612 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $29,195,665 | | 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 | 107141 |
| Policy instance | 11 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $730,353 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 134951 |
| Policy instance | 10 |
| Insurance contract or identification number | 134951 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,733,427 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393 & 394 |
| Policy instance | 9 |
| Insurance contract or identification number | 393 & 394 | | Number of Individuals Covered | 680 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,403,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | H2001 |
| Policy instance | 12 |
| Insurance contract or identification number | H2001 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $788,430 | | 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 | 117786 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 19311 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,644,017 | | 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 | 12166751 ET AL. |
| Policy instance | 3 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 9807 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,556,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 4 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 9347 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $238,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 5 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 10879 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231149 |
| Policy instance | 8 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2840 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,531,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 7 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 9403 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,382,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793, 716797 |
| Policy instance | 6 |
| Insurance contract or identification number | 711793, 716797 | | Number of Individuals Covered | 8829 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,207,302 | | 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 | 12166751 ET AL. |
| Policy instance | 3 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 9600 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,595,266 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | H2001 |
| Policy instance | 13 |
| Insurance contract or identification number | H2001 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $844,110 | | 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 | 233263 |
| Policy instance | 12 |
| Insurance contract or identification number | 233263 | | Number of Individuals Covered | 1423 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,806,201 | | 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 | 134951 |
| Policy instance | 11 |
| Insurance contract or identification number | 134951 | | Number of Individuals Covered | 734 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,697,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393 & 394 |
| Policy instance | 10 |
| Insurance contract or identification number | 393 & 394 | | Number of Individuals Covered | 723 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,335,127 | | 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 | 231149 |
| Policy instance | 9 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2917 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,229,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 8 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 9681 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,570,206 | | 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 | 117786 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 17292 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,665,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793, 716797 |
| Policy instance | 7 |
| Insurance contract or identification number | 711793, 716797 | | Number of Individuals Covered | 3206 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,605,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 6 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 11427 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 107141 |
| Policy instance | 5 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 1682 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,137,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 4 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 9096 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $247,436 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 1 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1642 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $31,353,102 | | 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 | 117786 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 17051 | | Insurance policy start date | 2016-05-01 | | Insurance policy end date | 2017-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,775,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 1 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1715 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $28,721,199 | | 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 | 233263 |
| Policy instance | 12 |
| Insurance contract or identification number | 233263 | | Number of Individuals Covered | 1529 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,922,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | H2001 |
| Policy instance | 13 |
| Insurance contract or identification number | H2001 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,238 | | 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 | 134951 |
| Policy instance | 11 |
| Insurance contract or identification number | 134951 | | Number of Individuals Covered | 870 | | Insurance policy start date | 2016-12-01 | | Insurance policy end date | 2017-01-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,713,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393 & 394 |
| Policy instance | 10 |
| Insurance contract or identification number | 393 & 394 | | Number of Individuals Covered | 577 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $954,990 | | 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 | 231149 |
| Policy instance | 9 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2884 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,329,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 8 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 10952 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,457,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793, 716797 |
| Policy instance | 7 |
| Insurance contract or identification number | 711793, 716797 | | Number of Individuals Covered | 3124 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,577,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 6 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 10732 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 4 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 9890 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $270,582 | | 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 | 107141 |
| Policy instance | 5 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 1848 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,310,148 | | 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 | 12166751 ET AL. |
| Policy instance | 3 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 10374 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,672,436 | | 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 | 117786 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 16191 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,789,358 | | 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 | 107141 |
| Policy instance | 5 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 2027 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,086,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 8 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 10645 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,534,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 1 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1618 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $23,337,898 | | 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 | 12166751 ET AL. |
| Policy instance | 3 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 9300 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 4 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 8612 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $222,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 6 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 7537 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793 ET AL. |
| Policy instance | 7 |
| Insurance contract or identification number | 711793 ET AL. | | Number of Individuals Covered | 2889 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,633,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 393 & 394 |
| Policy instance | 10 |
| Insurance contract or identification number | 393 & 394 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $232,366 | | 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 | 231149 |
| Policy instance | 9 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2892 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,927,775 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C001 / 002 |
| Policy instance | 1 |
| Insurance contract or identification number | LH61C001 / 002 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Other welfare benefits provided | CHIROPRACTIC (TERMINATED) | | Welfare Benefit Premiums Paid to Carrier | USD $476,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 394 |
| Policy instance | 11 |
| Insurance contract or identification number | 394 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $227,737 | | 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 | 231149 |
| Policy instance | 10 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2886 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Welfare Benefit Premiums Paid to Carrier | USD $8,976,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318-100321 |
| Policy instance | 9 |
| Insurance contract or identification number | 100318-100321 | | Number of Individuals Covered | 10179 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,439,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793 ET AL |
| Policy instance | 8 |
| Insurance contract or identification number | 711793 ET AL | | Number of Individuals Covered | 2400 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $913,774 | | 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 | 107141 |
| Policy instance | 6 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 2172 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $9,145,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-0009 |
| Policy instance | 5 |
| Insurance contract or identification number | 93876-0009 | | Number of Individuals Covered | 8947 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,112 | | 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 | 12166751 ET AL |
| Policy instance | 4 |
| Insurance contract or identification number | 12166751 ET AL | | Number of Individuals Covered | 8359 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 117786 ET AL |
| Policy instance | 3 |
| Insurance contract or identification number | 117786 ET AL | | Number of Individuals Covered | 13805 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Welfare Benefit Premiums Paid to Carrier | USD $53,661,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | 103131 ET AL | | Number of Individuals Covered | 1665 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Welfare Benefit Premiums Paid to Carrier | USD $24,723,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015/119 ETAL |
| Policy instance | 7 |
| Insurance contract or identification number | 849015/119 ETAL | | Number of Individuals Covered | 6680 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131 ET AL. |
| Policy instance | 2 |
| Insurance contract or identification number | 103131 ET AL. | | Number of Individuals Covered | 1501 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $22,746,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318 ET AL. |
| Policy instance | 9 |
| Insurance contract or identification number | 100318 ET AL. | | Number of Individuals Covered | 10051 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,335,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 394 |
| Policy instance | 11 |
| Insurance contract or identification number | 394 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,378 | | 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 | 231149 |
| Policy instance | 10 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 2695 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,551,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 711793 ET AL. |
| Policy instance | 8 |
| Insurance contract or identification number | 711793 ET AL. | | Number of Individuals Covered | 2400 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,510,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 ET AL. |
| Policy instance | 7 |
| Insurance contract or identification number | 849015 ET AL. | | Number of Individuals Covered | 5792 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 107141 |
| Policy instance | 6 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 2158 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,373,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 5 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 7210 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $214,285 | | 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 | 12166751 ET AL. |
| Policy instance | 4 |
| Insurance contract or identification number | 12166751 ET AL. | | Number of Individuals Covered | 8065 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 117786 ET AL. |
| Policy instance | 3 |
| Insurance contract or identification number | 117786 ET AL. | | Number of Individuals Covered | 14430 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,827,342 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*002 ET AL |
| Policy instance | 1 |
| Insurance contract or identification number | LH61C*002 ET AL | | Number of Individuals Covered | 26597 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $486,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*001 |
| Policy instance | 2 |
| Insurance contract or identification number | LH61C*001 | | Number of Individuals Covered | 2603 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $49,323 | | 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 | 602597 |
| Policy instance | 18 |
| Insurance contract or identification number | 602597 | | Number of Individuals Covered | 607 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,543,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0711793 |
| Policy instance | 19 |
| Insurance contract or identification number | 0711793 | | Number of Individuals Covered | 2494 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,116,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0716797 |
| Policy instance | 20 |
| Insurance contract or identification number | 0716797 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,812,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318-100321 |
| Policy instance | 21 |
| Insurance contract or identification number | 100318-100321 | | Number of Individuals Covered | 9017 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,232,683 | | 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 | 230693 |
| Policy instance | 22 |
| Insurance contract or identification number | 230693 | | Number of Individuals Covered | 870 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,197,482 | | 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 | 231149 |
| Policy instance | 23 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 1909 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,416,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 394 |
| Policy instance | 25 |
| Insurance contract or identification number | 394 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,340 | | 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 | 30019678 |
| Policy instance | 24 |
| Insurance contract or identification number | 30019678 | | Number of Individuals Covered | 1282 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5921 |
| Policy instance | 26 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 10000968 |
| Policy instance | 27 |
| Insurance contract or identification number | 10000968 | | Number of Individuals Covered | 1760 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,279 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | SRSUPP |
| Policy instance | 28 |
| Insurance contract or identification number | SRSUPP | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SF61C*000 |
| Policy instance | 1 |
| Insurance contract or identification number | SF61C*000 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $2,832 | | 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 | 228998 |
| Policy instance | 17 |
| Insurance contract or identification number | 228998 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $764,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015, 849119 |
| Policy instance | 16 |
| Insurance contract or identification number | 849015, 849119 | | Number of Individuals Covered | 5567 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 117786 |
| Policy instance | 15 |
| Insurance contract or identification number | 117786 | | Number of Individuals Covered | 428 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $853,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*002 |
| Policy instance | 3 |
| Insurance contract or identification number | LH61C*002 | | Number of Individuals Covered | 23009 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $344,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103133 |
| Policy instance | 4 |
| Insurance contract or identification number | 103133 | | Number of Individuals Covered | 1677 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $24,039,026 | | 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 | 117787 |
| Policy instance | 5 |
| Insurance contract or identification number | 117787 | | Number of Individuals Covered | 4459 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,015,161 | | 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 | 117788 |
| Policy instance | 6 |
| Insurance contract or identification number | 117788 | | Number of Individuals Covered | 2774 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,142,174 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 117790 |
| Policy instance | 7 |
| Insurance contract or identification number | 117790 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $427,732 | | 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 | 12166752 |
| Policy instance | 8 |
| Insurance contract or identification number | 12166752 | | Number of Individuals Covered | 4601 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision 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 | 12166753 |
| Policy instance | 9 |
| Insurance contract or identification number | 12166753 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision 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 | 12166751 |
| Policy instance | 10 |
| Insurance contract or identification number | 12166751 | | Number of Individuals Covered | 2434 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 11 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 7521 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $207,494 | | 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 | 117789 |
| Policy instance | 12 |
| Insurance contract or identification number | 117789 | | Number of Individuals Covered | 1962 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,444,372 | | 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 | 107141 |
| Policy instance | 13 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 2339 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,753,898 | | 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 | 216/217 |
| Policy instance | 14 |
| Insurance contract or identification number | 216/217 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,343 | | 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 | 117788 |
| Policy instance | 7 |
| Insurance contract or identification number | 117788 | | Number of Individuals Covered | 4102 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,769,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 394 |
| Policy instance | 26 |
| Insurance contract or identification number | 394 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,952 | | 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 | 117786 |
| Policy instance | 16 |
| Insurance contract or identification number | 117786 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $899,865 | | 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 | 107141 |
| Policy instance | 14 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 2356 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,445,342 | | 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 | 117789 |
| Policy instance | 13 |
| Insurance contract or identification number | 117789 | | Number of Individuals Covered | 1990 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,229,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 12 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 7266 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $135,677 | | 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 | 12166751 |
| Policy instance | 11 |
| Insurance contract or identification number | 12166751 | | Number of Individuals Covered | 2430 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision 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 | 12166753 |
| Policy instance | 10 |
| Insurance contract or identification number | 12166753 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 117790 |
| Policy instance | 8 |
| Insurance contract or identification number | 117790 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $420,622 | | 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 | 117787 |
| Policy instance | 6 |
| Insurance contract or identification number | 117787 | | Number of Individuals Covered | 4642 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,271,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103135 |
| Policy instance | 5 |
| Insurance contract or identification number | 103135 | | Number of Individuals Covered | 1807 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $19,251,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*002 |
| Policy instance | 4 |
| Insurance contract or identification number | LH61C*002 | | Number of Individuals Covered | 21251 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $306,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*001 |
| Policy instance | 3 |
| Insurance contract or identification number | LH61C*001 | | Number of Individuals Covered | 1984 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $38,043 | | 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 | 216/217 |
| Policy instance | 15 |
| Insurance contract or identification number | 216/217 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | SRSUPP |
| Policy instance | 29 |
| Insurance contract or identification number | SRSUPP | | Number of Individuals Covered | 38 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015, 849119 |
| Policy instance | 17 |
| Insurance contract or identification number | 849015, 849119 | | Number of Individuals Covered | 5567 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 228998 |
| Policy instance | 18 |
| Insurance contract or identification number | 228998 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $757,274 | | 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 | 602597 |
| Policy instance | 19 |
| Insurance contract or identification number | 602597 | | Number of Individuals Covered | 766 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,324,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0711793 |
| Policy instance | 20 |
| Insurance contract or identification number | 0711793 | | Number of Individuals Covered | 2905 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,294,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0716797 |
| Policy instance | 21 |
| Insurance contract or identification number | 0716797 | | Number of Individuals Covered | 573 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,759,926 | | 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 | 230693 |
| Policy instance | 23 |
| Insurance contract or identification number | 230693 | | Number of Individuals Covered | 1663 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,124,847 | | 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 | 231149 |
| Policy instance | 24 |
| Insurance contract or identification number | 231149 | | Number of Individuals Covered | 1914 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,058,805 | | 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 | 30019678 |
| Policy instance | 25 |
| Insurance contract or identification number | 30019678 | | Number of Individuals Covered | 1282 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5921 |
| Policy instance | 27 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 10000988 |
| Policy instance | 28 |
| Insurance contract or identification number | 10000988 | | Number of Individuals Covered | 1760 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $479,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SF61C*000 |
| Policy instance | 2 |
| Insurance contract or identification number | SF61C*000 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $2,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | N2952A |
| Policy instance | 1 |
| Insurance contract or identification number | N2952A | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2011-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $299,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318-100321 |
| Policy instance | 22 |
| Insurance contract or identification number | 100318-100321 | | Number of Individuals Covered | 7157 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $821,319 | | 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 | 12166752 |
| Policy instance | 9 |
| Insurance contract or identification number | 12166752 | | Number of Individuals Covered | 3958 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 100318-100321 |
| Policy instance | 25 |
| Insurance contract or identification number | 100318-100321 | | Number of Individuals Covered | 3712 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $496,946 | | 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 | 117786 |
| Policy instance | 17 |
| Insurance contract or identification number | 117786 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,816,627 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 849015 |
| Policy instance | 18 |
| Insurance contract or identification number | 849015 | | Number of Individuals Covered | 5604 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 228998 |
| Policy instance | 19 |
| Insurance contract or identification number | 228998 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $682,655 | | 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 | 216/217 |
| Policy instance | 16 |
| Insurance contract or identification number | 216/217 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 602597 |
| Policy instance | 20 |
| Insurance contract or identification number | 602597 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,645,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0711793 |
| Policy instance | 21 |
| Insurance contract or identification number | 0711793 | | Number of Individuals Covered | 7990 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,233,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2547 |
| Policy instance | 27 |
| Insurance contract or identification number | 2547 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF NEVADA (National Association of Insurance Commissioners NAIC id number: 95685 ) |
| Policy contract number | 68501 |
| Policy instance | 22 |
| Insurance contract or identification number | 68501 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $39,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFICARE BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 70785 ) |
| Policy contract number | 103131 - 104294 |
| Policy instance | 23 |
| Insurance contract or identification number | 103131 - 104294 | | Number of Individuals Covered | 1328 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $351,533 | | 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 | 230693 |
| Policy instance | 26 |
| Insurance contract or identification number | 230693 | | Number of Individuals Covered | 1421 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,763,738 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 716797 |
| Policy instance | 24 |
| Insurance contract or identification number | 716797 | | Number of Individuals Covered | 529 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,044,498 | | 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 | 12166751 |
| Policy instance | 12 |
| Insurance contract or identification number | 12166751 | | Number of Individuals Covered | 1038 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 740468 |
| Policy instance | 28 |
| Insurance contract or identification number | 740468 | | Number of Individuals Covered | 1365 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2010-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SF61C*000 |
| Policy instance | 2 |
| Insurance contract or identification number | SF61C*000 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $3,859 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | N2952A,64830A, |
| Policy instance | 1 |
| Insurance contract or identification number | N2952A,64830A, | | Number of Individuals Covered | 256 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,174,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*002 |
| Policy instance | 4 |
| Insurance contract or identification number | LH61C*002 | | Number of Individuals Covered | 17279 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $281,681 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 103131/140293 |
| Policy instance | 5 |
| Insurance contract or identification number | 103131/140293 | | Number of Individuals Covered | 1299 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $14,808,977 | | 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 | 117787 |
| Policy instance | 7 |
| Insurance contract or identification number | 117787 | | Number of Individuals Covered | 4747 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,760,317 | | 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 | 117788 |
| Policy instance | 8 |
| Insurance contract or identification number | 117788 | | Number of Individuals Covered | 3131 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,168,485 | | 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 | 117790 |
| Policy instance | 9 |
| Insurance contract or identification number | 117790 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $374,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 740469 |
| Policy instance | 6 |
| Insurance contract or identification number | 740469 | | Number of Individuals Covered | 1148 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2010-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 12166752 |
| Policy instance | 10 |
| Insurance contract or identification number | 12166752 | | Number of Individuals Covered | 1416 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision 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 | 12166753 |
| Policy instance | 11 |
| Insurance contract or identification number | 12166753 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93876-009 |
| Policy instance | 13 |
| Insurance contract or identification number | 93876-009 | | Number of Individuals Covered | 6035 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $184,797 | | 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 | 117789 |
| Policy instance | 14 |
| Insurance contract or identification number | 117789 | | Number of Individuals Covered | 1682 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,201,350 | | 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 | 107141 |
| Policy instance | 15 |
| Insurance contract or identification number | 107141 | | Number of Individuals Covered | 2293 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,981,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | LH61C*001 |
| Policy instance | 3 |
| Insurance contract or identification number | LH61C*001 | | Number of Individuals Covered | 1584 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHIROPRACTIC | | Welfare Benefit Premiums Paid to Carrier | USD $32,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
