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SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 401k Plan overview

Plan NameSAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND
Plan identification number 501

SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision

401k Sponsoring company profile

SAN MATEO HOTEL EMPLOYEES & has sponsored the creation of one or more 401k plans.

Company Name:SAN MATEO HOTEL EMPLOYEES &
Employer identification number (EIN):946081299
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01SHERRI CHIESA2023-10-12 JAMES BEARD2023-10-12
5012021-01-01SHERRI CHIESA2022-10-11 JAMES BEARD2022-10-10
5012020-01-01SHERRI CHIESA2021-10-07 JAMES BEARD2021-10-07
5012019-01-01SHERRI CHIESA2020-09-23 JAMES BEARD2020-09-23
5012018-01-01SHERRI CHIESA2019-09-29 JAMES BEARD2019-09-29
5012017-01-01
5012016-01-01
5012015-01-01MIKE CASEY
5012014-01-01MIKE CASEY
5012013-01-01SHERRI CHIESA
5012012-01-01MIKE CASEY
5012011-01-01SHERRI CHIESA
5012009-01-01JAMES O. BEARD

Plan Statistics for SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND

401k plan membership statisitcs for SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND

Measure Date Value
2022: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2022 401k membership
Total participants, beginning-of-year2022-01-011,566
Total number of active participants reported on line 7a of the Form 55002022-01-011,814
Total of all active and inactive participants2022-01-011,814
Number of employers contributing to the scheme2022-01-0149
2021: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2021 401k membership
Total participants, beginning-of-year2021-01-01990
Total number of active participants reported on line 7a of the Form 55002021-01-011,566
Total of all active and inactive participants2021-01-011,566
Number of employers contributing to the scheme2021-01-0149
2020: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2020 401k membership
Total participants, beginning-of-year2020-01-012,039
Total number of active participants reported on line 7a of the Form 55002020-01-01990
Total of all active and inactive participants2020-01-01990
Number of employers contributing to the scheme2020-01-0143
2019: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2019 401k membership
Total participants, beginning-of-year2019-01-011,925
Total number of active participants reported on line 7a of the Form 55002019-01-012,039
Total of all active and inactive participants2019-01-012,039
Number of employers contributing to the scheme2019-01-0147
2018: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2018 401k membership
Total participants, beginning-of-year2018-01-011,840
Total number of active participants reported on line 7a of the Form 55002018-01-011,925
Total of all active and inactive participants2018-01-011,925
Number of employers contributing to the scheme2018-01-0155
2017: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2017 401k membership
Total participants, beginning-of-year2017-01-011,659
Total number of active participants reported on line 7a of the Form 55002017-01-011,840
Total of all active and inactive participants2017-01-011,840
Number of employers contributing to the scheme2017-01-0167
2016: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-01-011,592
Total number of active participants reported on line 7a of the Form 55002016-01-011,659
Total of all active and inactive participants2016-01-011,659
Number of employers contributing to the scheme2016-01-0164
2015: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-01-011,567
Total number of active participants reported on line 7a of the Form 55002015-01-011,592
Total of all active and inactive participants2015-01-011,592
Number of employers contributing to the scheme2015-01-0162
2014: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-01-011,568
Total number of active participants reported on line 7a of the Form 55002014-01-011,567
Total of all active and inactive participants2014-01-011,567
Number of employers contributing to the scheme2014-01-0159
2013: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-01-011,469
Total number of active participants reported on line 7a of the Form 55002013-01-011,568
Total of all active and inactive participants2013-01-011,568
Number of employers contributing to the scheme2013-01-0162
2012: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-01-011,464
Total number of active participants reported on line 7a of the Form 55002012-01-011,469
Total of all active and inactive participants2012-01-011,469
Number of employers contributing to the scheme2012-01-0165
2011: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-01-011,399
Total number of active participants reported on line 7a of the Form 55002011-01-011,464
Total of all active and inactive participants2011-01-011,464
Number of employers contributing to the scheme2011-01-0162
2009: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-01-011,328
Total number of active participants reported on line 7a of the Form 55002009-01-011,369
Total of all active and inactive participants2009-01-011,369
Number of employers contributing to the scheme2009-01-0163

Financial Data on SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND

Measure Date Value
2022 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-382,695
Total unrealized appreciation/depreciation of assets2022-12-31$-382,695
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$9,976,256
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$7,618,854
Total income from all sources (including contributions)2022-12-31$30,355,871
Total loss/gain on sale of assets2022-12-31$-413,422
Total of all expenses incurred2022-12-31$29,900,165
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$28,923,611
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$29,304,104
Value of total assets at end of year2022-12-31$21,151,623
Value of total assets at beginning of year2022-12-31$18,338,515
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$976,554
Total interest from all sources2022-12-31$186,891
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$20,313
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$274,506
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$2,446,078
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$804,842
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$3,118,302
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$2,136,488
Other income not declared elsewhere2022-12-31$1,640,680
Administrative expenses (other) incurred2022-12-31$260,565
Liabilities. Value of operating payables at end of year2022-12-31$8,267
Liabilities. Value of operating payables at beginning of year2022-12-31$16,126
Total non interest bearing cash at end of year2022-12-31$2,291,319
Total non interest bearing cash at beginning of year2022-12-31$293,213
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$455,706
Value of net assets at end of year (total assets less liabilities)2022-12-31$11,175,367
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$10,719,661
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$51,613
Interest earned on other investments2022-12-31$8,965
Income. Interest from US Government securities2022-12-31$71,232
Income. Interest from corporate debt instruments2022-12-31$103,440
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$7,019,927
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$7,591,013
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$7,591,013
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$3,254
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$18,906,349
Asset value of US Government securities at end of year2022-12-31$1,529,758
Asset value of US Government securities at beginning of year2022-12-31$2,851,750
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$29,304,104
Employer contributions (assets) at end of year2022-12-31$2,885,285
Employer contributions (assets) at beginning of year2022-12-31$2,141,174
Income. Dividends from common stock2022-12-31$20,313
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$10,017,262
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$3,893,268
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$3,462,943
Contract administrator fees2022-12-31$389,870
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$1,085,988
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$1,193,580
Liabilities. Value of benefit claims payable at end of year2022-12-31$6,849,687
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$5,466,240
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$20,335,941
Aggregate carrying amount (costs) on sale of assets2022-12-31$20,749,363
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31INEICH COMPANY & LLP
Accountancy firm EIN2022-12-31562552172
2021 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$181,461
Total unrealized appreciation/depreciation of assets2021-12-31$181,461
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$7,618,854
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$8,288,490
Total income from all sources (including contributions)2021-12-31$16,838,266
Total loss/gain on sale of assets2021-12-31$-107,656
Total of all expenses incurred2021-12-31$19,640,097
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$18,887,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$15,755,693
Value of total assets at end of year2021-12-31$18,338,515
Value of total assets at beginning of year2021-12-31$21,809,982
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$752,597
Total interest from all sources2021-12-31$198,887
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$32,197
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$216,777
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$804,842
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$662,456
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$2,136,488
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$3,351,875
Other income not declared elsewhere2021-12-31$777,684
Administrative expenses (other) incurred2021-12-31$231,973
Liabilities. Value of operating payables at end of year2021-12-31$16,126
Liabilities. Value of operating payables at beginning of year2021-12-31$51,554
Total non interest bearing cash at end of year2021-12-31$293,213
Total non interest bearing cash at beginning of year2021-12-31$346,991
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-2,801,831
Value of net assets at end of year (total assets less liabilities)2021-12-31$10,719,661
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$13,521,492
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$62,508
Interest earned on other investments2021-12-31$725
Income. Interest from US Government securities2021-12-31$86,879
Income. Interest from corporate debt instruments2021-12-31$111,199
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$7,591,013
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$5,072,802
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$5,072,802
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$84
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$13,330,202
Asset value of US Government securities at end of year2021-12-31$2,851,750
Asset value of US Government securities at beginning of year2021-12-31$2,133,226
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$15,755,693
Employer contributions (assets) at end of year2021-12-31$2,141,174
Employer contributions (assets) at beginning of year2021-12-31$856,626
Income. Dividends from common stock2021-12-31$32,197
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$5,557,298
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$3,462,943
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$10,366,142
Contract administrator fees2021-12-31$241,339
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$1,193,580
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$2,371,739
Liabilities. Value of benefit claims payable at end of year2021-12-31$5,466,240
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$4,885,061
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$18,825,456
Aggregate carrying amount (costs) on sale of assets2021-12-31$18,933,112
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31INEICH COMPANY & LLP
Accountancy firm EIN2021-12-31562552172
2020 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$423,125
Total unrealized appreciation/depreciation of assets2020-12-31$423,125
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$8,288,490
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$10,574,946
Total income from all sources (including contributions)2020-12-31$15,321,921
Total loss/gain on sale of assets2020-12-31$567,309
Total of all expenses incurred2020-12-31$29,841,786
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$28,577,124
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$12,533,511
Value of total assets at end of year2020-12-31$21,809,982
Value of total assets at beginning of year2020-12-31$38,616,303
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,264,662
Total interest from all sources2020-12-31$354,611
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$78,423
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$223,458
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$662,456
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$812,593
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$3,351,875
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$4,570,557
Other income not declared elsewhere2020-12-31$1,364,942
Administrative expenses (other) incurred2020-12-31$440,294
Liabilities. Value of operating payables at end of year2020-12-31$51,554
Liabilities. Value of operating payables at beginning of year2020-12-31$32,818
Total non interest bearing cash at end of year2020-12-31$346,991
Total non interest bearing cash at beginning of year2020-12-31$1,231,290
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-14,519,865
Value of net assets at end of year (total assets less liabilities)2020-12-31$13,521,492
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$28,041,357
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$92,994
Interest earned on other investments2020-12-31$9,683
Income. Interest from US Government securities2020-12-31$35,332
Income. Interest from corporate debt instruments2020-12-31$306,668
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$5,072,802
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$9,252,830
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$9,252,830
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$2,928
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$19,637,709
Asset value of US Government securities at end of year2020-12-31$2,133,226
Asset value of US Government securities at beginning of year2020-12-31$5,554,209
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$12,533,511
Employer contributions (assets) at end of year2020-12-31$856,626
Employer contributions (assets) at beginning of year2020-12-31$2,836,293
Income. Dividends from common stock2020-12-31$78,423
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$8,939,415
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$10,366,142
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$13,554,472
Contract administrator fees2020-12-31$507,916
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$2,371,739
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$5,374,616
Liabilities. Value of benefit claims payable at end of year2020-12-31$4,885,061
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$5,971,571
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$27,257,124
Aggregate carrying amount (costs) on sale of assets2020-12-31$26,689,815
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31INEICH COMPANY & LLP
Accountancy firm EIN2020-12-31562552172
2019 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$1,506,477
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$1,506,477
Total unrealized appreciation/depreciation of assets2019-12-31$1,506,477
Total unrealized appreciation/depreciation of assets2019-12-31$1,506,477
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$10,574,946
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$10,574,946
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$8,687,445
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$8,687,445
Total income from all sources (including contributions)2019-12-31$33,494,105
Total income from all sources (including contributions)2019-12-31$33,494,105
Total loss/gain on sale of assets2019-12-31$206,175
Total loss/gain on sale of assets2019-12-31$206,175
Total of all expenses incurred2019-12-31$30,183,045
Total of all expenses incurred2019-12-31$30,183,045
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$29,129,847
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$29,129,847
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$30,338,996
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$30,338,996
Value of total assets at end of year2019-12-31$38,616,303
Value of total assets at end of year2019-12-31$38,616,303
Value of total assets at beginning of year2019-12-31$33,417,742
Value of total assets at beginning of year2019-12-31$33,417,742
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$1,053,198
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$1,053,198
Total interest from all sources2019-12-31$624,889
Total interest from all sources2019-12-31$624,889
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$117,548
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$117,548
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$246,416
Administrative expenses professional fees incurred2019-12-31$246,416
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$812,593
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$812,593
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$592,721
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$592,721
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$4,570,557
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$4,570,557
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$4,133,446
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$4,133,446
Other income not declared elsewhere2019-12-31$700,020
Other income not declared elsewhere2019-12-31$700,020
Administrative expenses (other) incurred2019-12-31$301,076
Administrative expenses (other) incurred2019-12-31$301,076
Liabilities. Value of operating payables at end of year2019-12-31$32,818
Liabilities. Value of operating payables at end of year2019-12-31$32,818
Liabilities. Value of operating payables at beginning of year2019-12-31$32,751
Liabilities. Value of operating payables at beginning of year2019-12-31$32,751
Total non interest bearing cash at end of year2019-12-31$1,231,290
Total non interest bearing cash at end of year2019-12-31$1,231,290
Total non interest bearing cash at beginning of year2019-12-31$1,227,650
Total non interest bearing cash at beginning of year2019-12-31$1,227,650
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,311,060
Value of net income/loss2019-12-31$3,311,060
Value of net assets at end of year (total assets less liabilities)2019-12-31$28,041,357
Value of net assets at end of year (total assets less liabilities)2019-12-31$28,041,357
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$24,730,297
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$24,730,297
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$102,700
Investment advisory and management fees2019-12-31$102,700
Income. Interest from US Government securities2019-12-31$129,542
Income. Interest from US Government securities2019-12-31$129,542
Income. Interest from corporate debt instruments2019-12-31$419,190
Income. Interest from corporate debt instruments2019-12-31$419,190
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$9,252,830
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$9,252,830
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$7,258,446
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$7,258,446
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$7,258,446
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$7,258,446
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$76,157
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$76,157
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$17,201,746
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$17,201,746
Asset value of US Government securities at end of year2019-12-31$5,554,209
Asset value of US Government securities at end of year2019-12-31$5,554,209
Asset value of US Government securities at beginning of year2019-12-31$6,463,413
Asset value of US Government securities at beginning of year2019-12-31$6,463,413
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$30,338,996
Contributions received in cash from employer2019-12-31$30,338,996
Employer contributions (assets) at end of year2019-12-31$2,836,293
Employer contributions (assets) at end of year2019-12-31$2,836,293
Employer contributions (assets) at beginning of year2019-12-31$2,278,942
Employer contributions (assets) at beginning of year2019-12-31$2,278,942
Income. Dividends from common stock2019-12-31$117,548
Income. Dividends from common stock2019-12-31$117,548
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$11,928,101
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$11,928,101
Asset. Corporate debt instrument debt (other) at end of year2019-12-31$13,554,472
Asset. Corporate debt instrument debt (other) at end of year2019-12-31$13,554,472
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$11,304,912
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$11,304,912
Contract administrator fees2019-12-31$403,006
Contract administrator fees2019-12-31$403,006
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$5,374,616
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$5,374,616
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$4,291,658
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$4,291,658
Liabilities. Value of benefit claims payable at end of year2019-12-31$5,971,571
Liabilities. Value of benefit claims payable at end of year2019-12-31$5,971,571
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$4,521,248
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$4,521,248
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$15,497,211
Aggregate proceeds on sale of assets2019-12-31$15,497,211
Aggregate carrying amount (costs) on sale of assets2019-12-31$15,291,036
Aggregate carrying amount (costs) on sale of assets2019-12-31$15,291,036
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31INEICH & COMPANY, LLP
Accountancy firm name2019-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2019-12-31562552172
2018 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$-786,077
Total unrealized appreciation/depreciation of assets2018-12-31$-786,077
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$8,687,445
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$8,725,619
Total income from all sources (including contributions)2018-12-31$26,780,883
Total loss/gain on sale of assets2018-12-31$-131,665
Total of all expenses incurred2018-12-31$26,052,192
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$25,058,496
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$26,766,471
Value of total assets at end of year2018-12-31$33,417,742
Value of total assets at beginning of year2018-12-31$32,727,225
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$993,696
Total interest from all sources2018-12-31$510,660
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$97,253
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$236,673
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$592,721
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$665,229
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$4,133,446
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$3,918,182
Other income not declared elsewhere2018-12-31$324,241
Administrative expenses (other) incurred2018-12-31$299,381
Liabilities. Value of operating payables at end of year2018-12-31$32,751
Liabilities. Value of operating payables at beginning of year2018-12-31$45,604
Total non interest bearing cash at end of year2018-12-31$1,227,650
Total non interest bearing cash at beginning of year2018-12-31$838,987
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$728,691
Value of net assets at end of year (total assets less liabilities)2018-12-31$24,730,297
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$24,001,606
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$96,036
Interest earned on other investments2018-12-31$65,900
Income. Interest from US Government securities2018-12-31$166,097
Income. Interest from corporate debt instruments2018-12-31$271,955
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$7,258,446
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$5,808,110
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$5,808,110
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$6,708
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$16,020,472
Asset value of US Government securities at end of year2018-12-31$6,463,413
Asset value of US Government securities at beginning of year2018-12-31$6,005,569
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$26,766,471
Employer contributions (assets) at end of year2018-12-31$2,278,942
Employer contributions (assets) at beginning of year2018-12-31$2,016,001
Income. Dividends from common stock2018-12-31$97,253
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$9,038,024
Asset. Corporate debt instrument debt (other) at end of year2018-12-31$11,304,912
Asset. Corporate debt instrument debt (other) at beginning of year2018-12-31$12,355,430
Contract administrator fees2018-12-31$361,606
Assets. Corporate common stocks other than exployer securities at end of year2018-12-31$4,291,658
Assets. Corporate common stocks other than exployer securities at beginning of year2018-12-31$5,037,899
Liabilities. Value of benefit claims payable at end of year2018-12-31$4,521,248
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$4,761,833
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Aggregate proceeds on sale of assets2018-12-31$16,906,066
Aggregate carrying amount (costs) on sale of assets2018-12-31$17,037,731
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2018-12-31562552172
2017 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$787,303
Total unrealized appreciation/depreciation of assets2017-12-31$787,303
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$8,725,619
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$6,666,666
Total income from all sources (including contributions)2017-12-31$26,347,803
Total loss/gain on sale of assets2017-12-31$-27,254
Total of all expenses incurred2017-12-31$22,735,863
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$21,795,842
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$24,619,157
Value of total assets at end of year2017-12-31$32,727,225
Value of total assets at beginning of year2017-12-31$27,056,332
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$940,021
Total interest from all sources2017-12-31$308,773
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$59,739
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$246,316
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$665,229
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$381,170
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$3,918,182
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$3,629,991
Other income not declared elsewhere2017-12-31$600,085
Administrative expenses (other) incurred2017-12-31$305,249
Liabilities. Value of operating payables at end of year2017-12-31$45,604
Liabilities. Value of operating payables at beginning of year2017-12-31$29,363
Total non interest bearing cash at end of year2017-12-31$838,987
Total non interest bearing cash at beginning of year2017-12-31$5,361,117
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$3,611,940
Value of net assets at end of year (total assets less liabilities)2017-12-31$24,001,606
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$20,389,666
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$75,814
Interest earned on other investments2017-12-31$28,757
Income. Interest from US Government securities2017-12-31$81,112
Income. Interest from corporate debt instruments2017-12-31$195,957
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$5,808,110
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$5,236,587
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$5,236,587
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$2,947
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$13,000,412
Asset value of US Government securities at end of year2017-12-31$6,005,569
Asset value of US Government securities at beginning of year2017-12-31$4,226,892
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$24,619,157
Employer contributions (assets) at end of year2017-12-31$2,016,001
Employer contributions (assets) at beginning of year2017-12-31$2,156,691
Income. Dividends from common stock2017-12-31$59,739
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$8,795,430
Asset. Corporate debt instrument debt (other) at end of year2017-12-31$12,355,430
Asset. Corporate debt instrument debt (other) at beginning of year2017-12-31$6,806,526
Contract administrator fees2017-12-31$312,642
Assets. Corporate common stocks other than exployer securities at end of year2017-12-31$5,037,899
Assets. Corporate common stocks other than exployer securities at beginning of year2017-12-31$2,887,349
Liabilities. Value of benefit claims payable at end of year2017-12-31$4,761,833
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$3,007,312
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$7,279,225
Aggregate carrying amount (costs) on sale of assets2017-12-31$7,306,479
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2017-12-31562552172
2016 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$186,691
Total unrealized appreciation/depreciation of assets2016-12-31$186,691
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$6,666,666
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$6,050,811
Total income from all sources (including contributions)2016-12-31$25,172,454
Total loss/gain on sale of assets2016-12-31$135,506
Total of all expenses incurred2016-12-31$19,790,769
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$18,953,088
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$24,270,225
Value of total assets at end of year2016-12-31$27,056,332
Value of total assets at beginning of year2016-12-31$21,058,792
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$837,681
Total interest from all sources2016-12-31$277,576
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$47,072
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$194,956
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$381,170
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$393,006
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$3,629,991
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$3,083,183
Other income not declared elsewhere2016-12-31$255,384
Administrative expenses (other) incurred2016-12-31$303,457
Liabilities. Value of operating payables at end of year2016-12-31$29,363
Liabilities. Value of operating payables at beginning of year2016-12-31$10,991
Total non interest bearing cash at end of year2016-12-31$5,361,117
Total non interest bearing cash at beginning of year2016-12-31$3,038,999
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$5,381,685
Value of net assets at end of year (total assets less liabilities)2016-12-31$20,389,666
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$15,007,981
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$55,214
Interest earned on other investments2016-12-31$8,684
Income. Interest from US Government securities2016-12-31$81,783
Income. Interest from corporate debt instruments2016-12-31$186,391
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$5,236,587
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$4,450,803
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$4,450,803
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$718
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$12,345,686
Asset value of US Government securities at end of year2016-12-31$4,226,892
Asset value of US Government securities at beginning of year2016-12-31$5,097,495
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$24,270,225
Employer contributions (assets) at end of year2016-12-31$2,156,691
Employer contributions (assets) at beginning of year2016-12-31$1,954,443
Income. Dividends from common stock2016-12-31$47,072
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$6,607,402
Asset. Corporate debt instrument debt (other) at end of year2016-12-31$6,806,526
Asset. Corporate debt instrument debt (other) at beginning of year2016-12-31$3,828,348
Contract administrator fees2016-12-31$284,054
Assets. Corporate common stocks other than exployer securities at end of year2016-12-31$2,887,349
Assets. Corporate common stocks other than exployer securities at beginning of year2016-12-31$2,295,698
Liabilities. Value of benefit claims payable at end of year2016-12-31$3,007,312
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$2,956,637
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$11,311,095
Aggregate carrying amount (costs) on sale of assets2016-12-31$11,175,589
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2016-12-31562552172
2015 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$-217,677
Total unrealized appreciation/depreciation of assets2015-12-31$-217,677
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$6,050,811
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$6,020,180
Total income from all sources (including contributions)2015-12-31$20,509,955
Total loss/gain on sale of assets2015-12-31$-125,732
Total of all expenses incurred2015-12-31$19,132,529
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$18,338,497
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$20,335,366
Value of total assets at end of year2015-12-31$21,058,792
Value of total assets at beginning of year2015-12-31$19,650,735
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$794,032
Total interest from all sources2015-12-31$320,467
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$43,142
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$164,937
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$393,006
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$665,411
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$3,083,183
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$2,725,173
Other income not declared elsewhere2015-12-31$154,389
Administrative expenses (other) incurred2015-12-31$329,087
Liabilities. Value of operating payables at end of year2015-12-31$10,991
Liabilities. Value of operating payables at beginning of year2015-12-31$26,246
Total non interest bearing cash at end of year2015-12-31$3,038,999
Total non interest bearing cash at beginning of year2015-12-31$3,510,779
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$1,377,426
Value of net assets at end of year (total assets less liabilities)2015-12-31$15,007,981
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$13,630,555
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$51,575
Interest earned on other investments2015-12-31$1,476
Income. Interest from US Government securities2015-12-31$162,618
Income. Interest from corporate debt instruments2015-12-31$156,221
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$4,450,803
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$2,566,720
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$2,566,720
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$152
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$12,405,974
Asset value of US Government securities at end of year2015-12-31$5,097,495
Asset value of US Government securities at beginning of year2015-12-31$3,976,972
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$20,335,366
Employer contributions (assets) at end of year2015-12-31$1,954,443
Employer contributions (assets) at beginning of year2015-12-31$1,734,900
Income. Dividends from common stock2015-12-31$43,142
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$5,932,523
Asset. Corporate debt instrument debt (other) at end of year2015-12-31$3,828,348
Asset. Corporate debt instrument debt (other) at beginning of year2015-12-31$4,802,677
Contract administrator fees2015-12-31$248,433
Assets. Corporate common stocks other than exployer securities at end of year2015-12-31$2,295,698
Assets. Corporate common stocks other than exployer securities at beginning of year2015-12-31$2,393,276
Liabilities. Value of benefit claims payable at end of year2015-12-31$2,956,637
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$3,268,761
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$5,332,884
Aggregate carrying amount (costs) on sale of assets2015-12-31$5,458,616
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2015-12-31562552172
2014 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$166,544
Total unrealized appreciation/depreciation of assets2014-12-31$166,544
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$6,020,180
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$6,232,549
Total income from all sources (including contributions)2014-12-31$20,631,926
Total loss/gain on sale of assets2014-12-31$-59,041
Total of all expenses incurred2014-12-31$19,903,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$19,265,148
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$19,390,259
Value of total assets at end of year2014-12-31$19,650,735
Value of total assets at beginning of year2014-12-31$19,134,472
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$638,146
Total interest from all sources2014-12-31$275,908
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$34,624
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$126,289
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$634,187
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$665,411
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$116,726
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$2,725,173
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$2,525,364
Other income not declared elsewhere2014-12-31$823,632
Administrative expenses (other) incurred2014-12-31$202,106
Liabilities. Value of operating payables at end of year2014-12-31$26,246
Liabilities. Value of operating payables at beginning of year2014-12-31$25,473
Total non interest bearing cash at end of year2014-12-31$3,510,779
Total non interest bearing cash at beginning of year2014-12-31$5,607,979
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$728,632
Value of net assets at end of year (total assets less liabilities)2014-12-31$13,630,555
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$12,901,923
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$58,167
Interest earned on other investments2014-12-31$23,074
Income. Interest from US Government securities2014-12-31$163,777
Income. Interest from corporate debt instruments2014-12-31$88,899
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$2,566,720
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$2,501,521
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$2,501,521
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$158
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$12,824,053
Asset value of US Government securities at end of year2014-12-31$3,976,972
Asset value of US Government securities at beginning of year2014-12-31$4,143,377
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$19,390,259
Employer contributions (assets) at end of year2014-12-31$1,734,900
Employer contributions (assets) at beginning of year2014-12-31$1,667,957
Income. Dividends from common stock2014-12-31$34,624
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$6,441,095
Asset. Corporate debt instrument debt (other) at end of year2014-12-31$4,802,677
Asset. Corporate debt instrument debt (other) at beginning of year2014-12-31$2,546,591
Contract administrator fees2014-12-31$251,584
Assets. Corporate common stocks other than exployer securities at end of year2014-12-31$2,393,276
Assets. Corporate common stocks other than exployer securities at beginning of year2014-12-31$1,916,134
Liabilities. Value of benefit claims payable at end of year2014-12-31$3,268,761
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$3,681,712
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$20,201,793
Aggregate carrying amount (costs) on sale of assets2014-12-31$20,260,834
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2014-12-31562552172
2013 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$310,404
Total unrealized appreciation/depreciation of assets2013-12-31$310,404
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$6,232,549
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$4,828,113
Total income from all sources (including contributions)2013-12-31$20,136,171
Total loss/gain on sale of assets2013-12-31$-167,323
Total of all expenses incurred2013-12-31$18,456,860
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$17,793,363
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$19,509,276
Value of total assets at end of year2013-12-31$19,134,472
Value of total assets at beginning of year2013-12-31$16,050,725
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$663,497
Total interest from all sources2013-12-31$272,771
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$30,604
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$139,041
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$1,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Assets. Other investments not covered elsewhere at end of year2013-12-31$634,187
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$645,282
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$116,726
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$112,414
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$2,525,364
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$2,110,055
Other income not declared elsewhere2013-12-31$180,439
Administrative expenses (other) incurred2013-12-31$209,530
Liabilities. Value of operating payables at end of year2013-12-31$25,473
Liabilities. Value of operating payables at beginning of year2013-12-31$28,299
Total non interest bearing cash at end of year2013-12-31$5,607,979
Total non interest bearing cash at beginning of year2013-12-31$2,664,762
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$1,679,311
Value of net assets at end of year (total assets less liabilities)2013-12-31$12,901,923
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$11,222,612
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$56,068
Interest earned on other investments2013-12-31$22,985
Income. Interest from US Government securities2013-12-31$159,144
Income. Interest from corporate debt instruments2013-12-31$90,122
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$2,501,521
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$2,907,633
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$2,907,633
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$520
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$11,695,501
Asset value of US Government securities at end of year2013-12-31$4,143,377
Asset value of US Government securities at beginning of year2013-12-31$4,834,080
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$19,509,276
Employer contributions (assets) at end of year2013-12-31$1,667,957
Employer contributions (assets) at beginning of year2013-12-31$1,559,282
Income. Dividends from common stock2013-12-31$30,604
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$6,097,862
Asset. Corporate debt instrument debt (other) at end of year2013-12-31$2,546,591
Asset. Corporate debt instrument debt (other) at beginning of year2013-12-31$1,953,015
Contract administrator fees2013-12-31$258,858
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2013-12-31$1,916,134
Assets. Corporate common stocks other than exployer securities at beginning of year2013-12-31$1,374,257
Liabilities. Value of benefit claims payable at end of year2013-12-31$3,681,712
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$2,689,759
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$15,632,726
Aggregate carrying amount (costs) on sale of assets2013-12-31$15,800,049
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2013-12-31562552172
2012 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$161,651
Total unrealized appreciation/depreciation of assets2012-12-31$161,651
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$4,828,113
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$4,705,993
Total income from all sources (including contributions)2012-12-31$17,948,484
Total loss/gain on sale of assets2012-12-31$-50,638
Total of all expenses incurred2012-12-31$15,840,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$15,193,758
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$17,400,997
Value of total assets at end of year2012-12-31$16,050,725
Value of total assets at beginning of year2012-12-31$13,820,710
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$646,831
Total interest from all sources2012-12-31$264,319
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$27,148
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$154,132
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$1,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Assets. Other investments not covered elsewhere at end of year2012-12-31$645,282
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$287,131
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$112,414
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$75,838
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$2,110,055
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$1,764,471
Other income not declared elsewhere2012-12-31$145,007
Administrative expenses (other) incurred2012-12-31$171,862
Liabilities. Value of operating payables at end of year2012-12-31$28,299
Liabilities. Value of operating payables at beginning of year2012-12-31$26,002
Total non interest bearing cash at end of year2012-12-31$2,664,762
Total non interest bearing cash at beginning of year2012-12-31$849,797
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$2,107,895
Value of net assets at end of year (total assets less liabilities)2012-12-31$11,222,612
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$9,114,717
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$54,516
Interest earned on other investments2012-12-31$33,435
Income. Interest from US Government securities2012-12-31$152,315
Income. Interest from corporate debt instruments2012-12-31$77,923
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$2,907,633
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$3,052,779
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$3,052,779
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$646
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$10,433,705
Asset value of US Government securities at end of year2012-12-31$4,834,080
Asset value of US Government securities at beginning of year2012-12-31$4,241,207
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$17,400,997
Employer contributions (assets) at end of year2012-12-31$1,559,282
Employer contributions (assets) at beginning of year2012-12-31$1,403,386
Income. Dividends from common stock2012-12-31$27,148
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$4,760,053
Asset. Corporate debt instrument debt (other) at end of year2012-12-31$1,953,015
Asset. Corporate debt instrument debt (other) at beginning of year2012-12-31$2,733,785
Contract administrator fees2012-12-31$266,321
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2012-12-31$1,374,257
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$1,176,787
Liabilities. Value of benefit claims payable at end of year2012-12-31$2,689,759
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$2,915,520
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$12,746,921
Aggregate carrying amount (costs) on sale of assets2012-12-31$12,797,559
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2012-12-31562552172
2011 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets2011-12-31$-45,165
Total unrealized appreciation/depreciation of assets2011-12-31$-45,165
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$4,705,993
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$4,186,559
Total income from all sources (including contributions)2011-12-31$16,009,497
Total loss/gain on sale of assets2011-12-31$78,294
Total of all expenses incurred2011-12-31$14,791,697
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$14,137,260
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$15,724,695
Value of total assets at end of year2011-12-31$13,820,710
Value of total assets at beginning of year2011-12-31$12,083,476
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$654,437
Total interest from all sources2011-12-31$230,972
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$20,701
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$158,201
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$1,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Assets. Other investments not covered elsewhere at end of year2011-12-31$287,131
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$221,287
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$75,838
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$60,256
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$1,764,471
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$1,479,197
Administrative expenses (other) incurred2011-12-31$191,962
Liabilities. Value of operating payables at end of year2011-12-31$26,002
Liabilities. Value of operating payables at beginning of year2011-12-31$19,172
Total non interest bearing cash at end of year2011-12-31$849,797
Total non interest bearing cash at beginning of year2011-12-31$2,712,959
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$1,217,800
Value of net assets at end of year (total assets less liabilities)2011-12-31$9,114,717
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$7,896,917
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$47,479
Interest earned on other investments2011-12-31$7,607
Income. Interest from US Government securities2011-12-31$120,703
Income. Interest from corporate debt instruments2011-12-31$100,760
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$3,052,779
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$2,274,106
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$2,274,106
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$1,902
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$9,373,366
Asset value of US Government securities at end of year2011-12-31$4,241,207
Asset value of US Government securities at beginning of year2011-12-31$2,755,063
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$15,724,695
Employer contributions (assets) at end of year2011-12-31$1,403,386
Employer contributions (assets) at beginning of year2011-12-31$1,336,347
Income. Dividends from common stock2011-12-31$20,701
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$4,763,894
Asset. Corporate debt instrument debt (other) at end of year2011-12-31$2,733,785
Asset. Corporate debt instrument debt (other) at beginning of year2011-12-31$1,813,450
Contract administrator fees2011-12-31$256,795
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$1,176,787
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$910,008
Liabilities. Value of benefit claims payable at end of year2011-12-31$2,915,520
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$2,688,190
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$12,452,240
Aggregate carrying amount (costs) on sale of assets2011-12-31$12,373,946
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2011-12-31562552172
2010 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$9,662
Total unrealized appreciation/depreciation of assets2010-12-31$9,662
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$4,186,559
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$4,215,933
Total income from all sources (including contributions)2010-12-31$15,790,277
Total loss/gain on sale of assets2010-12-31$-30,071
Total of all expenses incurred2010-12-31$12,698,555
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$12,037,373
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$15,039,877
Value of total assets at end of year2010-12-31$12,083,476
Value of total assets at beginning of year2010-12-31$9,021,128
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$661,182
Total interest from all sources2010-12-31$18,321
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$473
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$119,673
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Assets. Other investments not covered elsewhere at end of year2010-12-31$221,287
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$60,256
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$31,121
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$1,479,197
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$1,205,025
Other income not declared elsewhere2010-12-31$226,867
Administrative expenses (other) incurred2010-12-31$251,812
Liabilities. Value of operating payables at end of year2010-12-31$19,172
Liabilities. Value of operating payables at beginning of year2010-12-31$18,742
Total non interest bearing cash at end of year2010-12-31$2,712,959
Total non interest bearing cash at beginning of year2010-12-31$1,207,504
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$3,091,722
Value of net assets at end of year (total assets less liabilities)2010-12-31$7,896,917
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$4,805,195
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$28,038
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$5,248,336
Interest earned on other investments2010-12-31$285
Income. Interest from US Government securities2010-12-31$9,704
Income. Interest from corporate debt instruments2010-12-31$6,707
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$2,274,106
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,400,918
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$1,400,918
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$1,625
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$7,981,681
Asset value of US Government securities at end of year2010-12-31$2,755,063
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$525,148
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$15,039,877
Employer contributions (assets) at end of year2010-12-31$1,336,347
Employer contributions (assets) at beginning of year2010-12-31$1,133,249
Income. Dividends from common stock2010-12-31$473
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$4,055,692
Asset. Corporate debt instrument debt (other) at end of year2010-12-31$1,813,450
Contract administrator fees2010-12-31$261,659
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$910,008
Liabilities. Value of benefit claims payable at end of year2010-12-31$2,688,190
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$2,992,166
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$2,285,972
Aggregate carrying amount (costs) on sale of assets2010-12-31$2,316,043
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31INEICH & COMPANY, LLP
Accountancy firm EIN2010-12-31562552172

Form 5500 Responses for SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND

2022: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2022 form 5500 responses
2022-01-01Type of plan entityMulti-employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2021 form 5500 responses
2021-01-01Type of plan entityMulti-employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2020 form 5500 responses
2020-01-01Type of plan entityMulti-employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2019 form 5500 responses
2019-01-01Type of plan entityMulti-employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2018 form 5500 responses
2018-01-01Type of plan entityMulti-employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2017 form 5500 responses
2017-01-01Type of plan entityMulti-employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2016 form 5500 responses
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2015 form 5500 responses
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2013 form 5500 responses
2013-01-01Type of plan entityMulti-employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2011 form 5500 responses
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2009 form 5500 responses
2009-01-01Type of plan entityMulti-employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1840
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $58,282
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 number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $198,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL36264
Policy instance 3
Insurance contract or identification numberHCL36264
Number of Individuals Covered739
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $44,872
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $897,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,872
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1853
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $156,369
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2536
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $14,235,672
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 number0711888
Policy instance 6
Insurance contract or identification number0711888
Number of Individuals Covered1313
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $485,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1593
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $39,783
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1579
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $109,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number
Policy instance 3
Number of Individuals Covered628
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $28,170
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $563,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,170
Insurance broker organization code?3
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered5
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $316,113
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 number0711888
Policy instance 6
Insurance contract or identification number0711888
Number of Individuals Covered847
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $261,451
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2249
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,530,744
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2221
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $16,435,085
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1501
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberSL10407
Policy instance 3
Insurance contract or identification numberSL10407
Number of Individuals Covered595
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $77,889
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $1,557,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,889
Insurance broker organization code?3
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered8
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $328,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1557
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $79,875
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 number0711888
Policy instance 6
Insurance contract or identification number0711888
Number of Individuals Covered915
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $635,866
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2579
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $14,763,708
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered2047
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 3
Insurance contract or identification numberSE3E50008
Number of Individuals Covered1029
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $60,195
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $1,203,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,195
Insurance broker organization code?3
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered2197
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $67,253
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 number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered8
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $321,426
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 number0711888
Policy instance 6
Insurance contract or identification number0711888
Number of Individuals Covered1312
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $493,731
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2419
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $14,645,104
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 number0711888
Policy instance 6
Insurance contract or identification number0711888
Number of Individuals Covered1190
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $438,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1945
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $62,842
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 number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered9
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $308,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 3
Insurance contract or identification numberSE3E50008
Number of Individuals Covered932
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $56,120
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $1,122,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,120
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1925
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $182,007
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 number0711888
Policy instance 6
Insurance contract or identification number0711888
Number of Individuals Covered1128
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $377,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1859
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $30,460
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 number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered11
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $307,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 3
Insurance contract or identification numberSE3E50008
Number of Individuals Covered971
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $51,237
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $1,024,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,237
Insurance broker organization code?3
Insurance broker nameSTOP LOSS INSURANCE SERVICES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1850
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $163,349
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2024
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,843,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered2018
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $10,964,127
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1592
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $149,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 3
Insurance contract or identification numberSE3E50008
Number of Individuals Covered697
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $42,896
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $857,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,896
Insurance broker organization code?3
Insurance broker nameSTOP LOSS INSURANCE SERVICES, INC.
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered11
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $231,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1594
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $27,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 3
Insurance contract or identification numberSE3E50008
Number of Individuals Covered775
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $616,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered1960
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,649,467
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 number401473
Policy instance 4
Insurance contract or identification number401473
Number of Individuals Covered11
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $290,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1588
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $27,417
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1534
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $153,156
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1608
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $151,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 5
Insurance contract or identification numberG8023
Number of Individuals Covered1344
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $45,913
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered1987
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $10,177,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 3
Insurance contract or identification numberSE3E50008
Number of Individuals Covered654
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $53,249
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $507,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,428
Insurance broker organization code?3
Insurance broker nameSTOP LOSS INSURANCE SERVICES-NC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0711888
Policy instance 4
Insurance contract or identification number0711888
Number of Individuals Covered1105
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $241,552
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 number8014
Policy instance 1
Insurance contract or identification number8014
Number of Individuals Covered1882
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $8,588,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 6
Insurance contract or identification numberG8023
Number of Individuals Covered1464
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $21,816
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 number0711888
Policy instance 5
Insurance contract or identification number0711888
Number of Individuals Covered688
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $234,956
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 number401473
Policy instance 3
Insurance contract or identification number401473
Number of Individuals Covered18
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $315,844
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1553
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $145,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 4
Insurance contract or identification numberSE3E50008
Number of Individuals Covered571
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $44,798
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $426,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,599
Insurance broker organization code?3
Insurance broker nameSTOP LOSS INSURANCE SERVICES-NC
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG8023
Policy instance 6
Insurance contract or identification numberG8023
Number of Individuals Covered1260
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $20,978
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 number0711888
Policy instance 5
Insurance contract or identification number0711888
Number of Individuals Covered959
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $230,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 4
Insurance contract or identification numberSE3E50008
Number of Individuals Covered588
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $46,548
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $443,311
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 number401473
Policy instance 3
Insurance contract or identification number401473
Number of Individuals Covered19
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $345,679
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1491
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $138,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8014-0000
Policy instance 1
Insurance contract or identification number8014-0000
Number of Individuals Covered1890
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $8,537,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3E50008
Policy instance 4
Insurance contract or identification numberSE3E50008
Number of Individuals Covered624
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $26,171
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIC STOP-LOSS
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 CarrierUSD $262,294
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 number401473
Policy instance 3
Insurance contract or identification number401473
Number of Individuals Covered20
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $346,407
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 number00410000
Policy instance 2
Insurance contract or identification number00410000
Number of Individuals Covered1451
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $134,905
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 number8014-0000
Policy instance 1
Insurance contract or identification number8014-0000
Number of Individuals Covered1659
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,703,047
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 number0711888
Policy instance 5
Insurance contract or identification number0711888
Number of Individuals Covered1123
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $239,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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