SAN MATEO HOTEL EMPLOYEES & has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan 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 financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2022-12-31 | $-382,695 |
Total unrealized appreciation/depreciation of assets | 2022-12-31 | $-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 assets | 2022-12-31 | $-413,422 |
Total of all expenses incurred | 2022-12-31 | $29,900,165 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $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 year | 2022-12-31 | $21,151,623 |
Value of total assets at beginning of year | 2022-12-31 | $18,338,515 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $976,554 |
Total interest from all sources | 2022-12-31 | $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 year | 2022-12-31 | No |
Administrative expenses professional fees incurred | 2022-12-31 | $274,506 |
Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
Value of fidelity bond cover | 2022-12-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $2,446,078 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $804,842 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $3,118,302 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $2,136,488 |
Other income not declared elsewhere | 2022-12-31 | $1,640,680 |
Administrative expenses (other) incurred | 2022-12-31 | $260,565 |
Liabilities. Value of operating payables at end of year | 2022-12-31 | $8,267 |
Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $16,126 |
Total non interest bearing cash at end of year | 2022-12-31 | $2,291,319 |
Total non interest bearing cash at beginning of year | 2022-12-31 | $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 appraiser | 2022-12-31 | No |
Value of net income/loss | 2022-12-31 | $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) | 2022-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
Investment advisory and management fees | 2022-12-31 | $51,613 |
Interest earned on other investments | 2022-12-31 | $8,965 |
Income. Interest from US Government securities | 2022-12-31 | $71,232 |
Income. Interest from corporate debt instruments | 2022-12-31 | $103,440 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $7,019,927 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $7,591,013 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $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 benefits | 2022-12-31 | $18,906,349 |
Asset value of US Government securities at end of year | 2022-12-31 | $1,529,758 |
Asset value of US Government securities at beginning of year | 2022-12-31 | $2,851,750 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
Contributions received in cash from employer | 2022-12-31 | $29,304,104 |
Employer contributions (assets) at end of year | 2022-12-31 | $2,885,285 |
Employer contributions (assets) at beginning of year | 2022-12-31 | $2,141,174 |
Income. Dividends from common stock | 2022-12-31 | $20,313 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $10,017,262 |
Asset. Corporate debt instrument debt (other) at end of year | 2022-12-31 | $3,893,268 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2022-12-31 | $3,462,943 |
Contract administrator fees | 2022-12-31 | $389,870 |
Assets. Corporate common stocks other than exployer securities at end of year | 2022-12-31 | $1,085,988 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2022-12-31 | $1,193,580 |
Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $6,849,687 |
Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $5,466,240 |
Did the plan have assets held for investment | 2022-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
Aggregate proceeds on sale of assets | 2022-12-31 | $20,335,941 |
Aggregate carrying amount (costs) on sale of assets | 2022-12-31 | $20,749,363 |
Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
Accountancy firm name | 2022-12-31 | INEICH COMPANY & LLP |
Accountancy firm EIN | 2022-12-31 | 562552172 |
2021 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2021 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2021-12-31 | $181,461 |
Total unrealized appreciation/depreciation of assets | 2021-12-31 | $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 assets | 2021-12-31 | $-107,656 |
Total of all expenses incurred | 2021-12-31 | $19,640,097 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $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 year | 2021-12-31 | $18,338,515 |
Value of total assets at beginning of year | 2021-12-31 | $21,809,982 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $752,597 |
Total interest from all sources | 2021-12-31 | $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 year | 2021-12-31 | No |
Administrative expenses professional fees incurred | 2021-12-31 | $216,777 |
Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
Value of fidelity bond cover | 2021-12-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $804,842 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $662,456 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $2,136,488 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $3,351,875 |
Other income not declared elsewhere | 2021-12-31 | $777,684 |
Administrative expenses (other) incurred | 2021-12-31 | $231,973 |
Liabilities. Value of operating payables at end of year | 2021-12-31 | $16,126 |
Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $51,554 |
Total non interest bearing cash at end of year | 2021-12-31 | $293,213 |
Total non interest bearing cash at beginning of year | 2021-12-31 | $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 appraiser | 2021-12-31 | No |
Value of net income/loss | 2021-12-31 | $-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) | 2021-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
Investment advisory and management fees | 2021-12-31 | $62,508 |
Interest earned on other investments | 2021-12-31 | $725 |
Income. Interest from US Government securities | 2021-12-31 | $86,879 |
Income. Interest from corporate debt instruments | 2021-12-31 | $111,199 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $7,591,013 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $5,072,802 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $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 benefits | 2021-12-31 | $13,330,202 |
Asset value of US Government securities at end of year | 2021-12-31 | $2,851,750 |
Asset value of US Government securities at beginning of year | 2021-12-31 | $2,133,226 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
Contributions received in cash from employer | 2021-12-31 | $15,755,693 |
Employer contributions (assets) at end of year | 2021-12-31 | $2,141,174 |
Employer contributions (assets) at beginning of year | 2021-12-31 | $856,626 |
Income. Dividends from common stock | 2021-12-31 | $32,197 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $5,557,298 |
Asset. Corporate debt instrument debt (other) at end of year | 2021-12-31 | $3,462,943 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2021-12-31 | $10,366,142 |
Contract administrator fees | 2021-12-31 | $241,339 |
Assets. Corporate common stocks other than exployer securities at end of year | 2021-12-31 | $1,193,580 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2021-12-31 | $2,371,739 |
Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $5,466,240 |
Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $4,885,061 |
Did the plan have assets held for investment | 2021-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
Aggregate proceeds on sale of assets | 2021-12-31 | $18,825,456 |
Aggregate carrying amount (costs) on sale of assets | 2021-12-31 | $18,933,112 |
Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
Accountancy firm name | 2021-12-31 | INEICH COMPANY & LLP |
Accountancy firm EIN | 2021-12-31 | 562552172 |
2020 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2020 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2020-12-31 | $423,125 |
Total unrealized appreciation/depreciation of assets | 2020-12-31 | $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 assets | 2020-12-31 | $567,309 |
Total of all expenses incurred | 2020-12-31 | $29,841,786 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $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 year | 2020-12-31 | $21,809,982 |
Value of total assets at beginning of year | 2020-12-31 | $38,616,303 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $1,264,662 |
Total interest from all sources | 2020-12-31 | $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 year | 2020-12-31 | No |
Administrative expenses professional fees incurred | 2020-12-31 | $223,458 |
Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
Value of fidelity bond cover | 2020-12-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $662,456 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $812,593 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $3,351,875 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $4,570,557 |
Other income not declared elsewhere | 2020-12-31 | $1,364,942 |
Administrative expenses (other) incurred | 2020-12-31 | $440,294 |
Liabilities. Value of operating payables at end of year | 2020-12-31 | $51,554 |
Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $32,818 |
Total non interest bearing cash at end of year | 2020-12-31 | $346,991 |
Total non interest bearing cash at beginning of year | 2020-12-31 | $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 appraiser | 2020-12-31 | No |
Value of net income/loss | 2020-12-31 | $-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) | 2020-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
Investment advisory and management fees | 2020-12-31 | $92,994 |
Interest earned on other investments | 2020-12-31 | $9,683 |
Income. Interest from US Government securities | 2020-12-31 | $35,332 |
Income. Interest from corporate debt instruments | 2020-12-31 | $306,668 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $5,072,802 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $9,252,830 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $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 benefits | 2020-12-31 | $19,637,709 |
Asset value of US Government securities at end of year | 2020-12-31 | $2,133,226 |
Asset value of US Government securities at beginning of year | 2020-12-31 | $5,554,209 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
Contributions received in cash from employer | 2020-12-31 | $12,533,511 |
Employer contributions (assets) at end of year | 2020-12-31 | $856,626 |
Employer contributions (assets) at beginning of year | 2020-12-31 | $2,836,293 |
Income. Dividends from common stock | 2020-12-31 | $78,423 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $8,939,415 |
Asset. Corporate debt instrument debt (other) at end of year | 2020-12-31 | $10,366,142 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2020-12-31 | $13,554,472 |
Contract administrator fees | 2020-12-31 | $507,916 |
Assets. Corporate common stocks other than exployer securities at end of year | 2020-12-31 | $2,371,739 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2020-12-31 | $5,374,616 |
Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $4,885,061 |
Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $5,971,571 |
Did the plan have assets held for investment | 2020-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
Aggregate proceeds on sale of assets | 2020-12-31 | $27,257,124 |
Aggregate carrying amount (costs) on sale of assets | 2020-12-31 | $26,689,815 |
Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
Accountancy firm name | 2020-12-31 | INEICH COMPANY & LLP |
Accountancy firm EIN | 2020-12-31 | 562552172 |
2019 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2019 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2019-12-31 | $1,506,477 |
Unrealized appreciation/depreciation of other (non real estate) assets | 2019-12-31 | $1,506,477 |
Total unrealized appreciation/depreciation of assets | 2019-12-31 | $1,506,477 |
Total unrealized appreciation/depreciation of assets | 2019-12-31 | $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 assets | 2019-12-31 | $206,175 |
Total loss/gain on sale of assets | 2019-12-31 | $206,175 |
Total of all expenses incurred | 2019-12-31 | $30,183,045 |
Total of all expenses incurred | 2019-12-31 | $30,183,045 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $29,129,847 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $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 year | 2019-12-31 | $38,616,303 |
Value of total assets at end of year | 2019-12-31 | $38,616,303 |
Value of total assets at beginning of year | 2019-12-31 | $33,417,742 |
Value of total assets at beginning of year | 2019-12-31 | $33,417,742 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,053,198 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,053,198 |
Total interest from all sources | 2019-12-31 | $624,889 |
Total interest from all sources | 2019-12-31 | $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 year | 2019-12-31 | No |
Administrative expenses professional fees incurred | 2019-12-31 | $246,416 |
Administrative expenses professional fees incurred | 2019-12-31 | $246,416 |
Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
Value of fidelity bond cover | 2019-12-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $812,593 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $812,593 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $592,721 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $592,721 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $4,570,557 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $4,570,557 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $4,133,446 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $4,133,446 |
Other income not declared elsewhere | 2019-12-31 | $700,020 |
Other income not declared elsewhere | 2019-12-31 | $700,020 |
Administrative expenses (other) incurred | 2019-12-31 | $301,076 |
Administrative expenses (other) incurred | 2019-12-31 | $301,076 |
Liabilities. Value of operating payables at end of year | 2019-12-31 | $32,818 |
Liabilities. Value of operating payables at end of year | 2019-12-31 | $32,818 |
Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $32,751 |
Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $32,751 |
Total non interest bearing cash at end of year | 2019-12-31 | $1,231,290 |
Total non interest bearing cash at end of year | 2019-12-31 | $1,231,290 |
Total non interest bearing cash at beginning of year | 2019-12-31 | $1,227,650 |
Total non interest bearing cash at beginning of year | 2019-12-31 | $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 appraiser | 2019-12-31 | No |
Value of net income/loss | 2019-12-31 | $3,311,060 |
Value of net income/loss | 2019-12-31 | $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) | 2019-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
Investment advisory and management fees | 2019-12-31 | $102,700 |
Investment advisory and management fees | 2019-12-31 | $102,700 |
Income. Interest from US Government securities | 2019-12-31 | $129,542 |
Income. Interest from US Government securities | 2019-12-31 | $129,542 |
Income. Interest from corporate debt instruments | 2019-12-31 | $419,190 |
Income. Interest from corporate debt instruments | 2019-12-31 | $419,190 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $9,252,830 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $9,252,830 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $7,258,446 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $7,258,446 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $7,258,446 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $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 benefits | 2019-12-31 | $17,201,746 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $17,201,746 |
Asset value of US Government securities at end of year | 2019-12-31 | $5,554,209 |
Asset value of US Government securities at end of year | 2019-12-31 | $5,554,209 |
Asset value of US Government securities at beginning of year | 2019-12-31 | $6,463,413 |
Asset value of US Government securities at beginning of year | 2019-12-31 | $6,463,413 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
Contributions received in cash from employer | 2019-12-31 | $30,338,996 |
Contributions received in cash from employer | 2019-12-31 | $30,338,996 |
Employer contributions (assets) at end of year | 2019-12-31 | $2,836,293 |
Employer contributions (assets) at end of year | 2019-12-31 | $2,836,293 |
Employer contributions (assets) at beginning of year | 2019-12-31 | $2,278,942 |
Employer contributions (assets) at beginning of year | 2019-12-31 | $2,278,942 |
Income. Dividends from common stock | 2019-12-31 | $117,548 |
Income. Dividends from common stock | 2019-12-31 | $117,548 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $11,928,101 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $11,928,101 |
Asset. Corporate debt instrument debt (other) at end of year | 2019-12-31 | $13,554,472 |
Asset. Corporate debt instrument debt (other) at end of year | 2019-12-31 | $13,554,472 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2019-12-31 | $11,304,912 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2019-12-31 | $11,304,912 |
Contract administrator fees | 2019-12-31 | $403,006 |
Contract administrator fees | 2019-12-31 | $403,006 |
Assets. Corporate common stocks other than exployer securities at end of year | 2019-12-31 | $5,374,616 |
Assets. Corporate common stocks other than exployer securities at end of year | 2019-12-31 | $5,374,616 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2019-12-31 | $4,291,658 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2019-12-31 | $4,291,658 |
Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $5,971,571 |
Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $5,971,571 |
Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $4,521,248 |
Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $4,521,248 |
Did the plan have assets held for investment | 2019-12-31 | Yes |
Did the plan have assets held for investment | 2019-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
Aggregate proceeds on sale of assets | 2019-12-31 | $15,497,211 |
Aggregate proceeds on sale of assets | 2019-12-31 | $15,497,211 |
Aggregate carrying amount (costs) on sale of assets | 2019-12-31 | $15,291,036 |
Aggregate carrying amount (costs) on sale of assets | 2019-12-31 | $15,291,036 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
Accountancy firm name | 2019-12-31 | INEICH & COMPANY, LLP |
Accountancy firm name | 2019-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2019-12-31 | 562552172 |
2018 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2018 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2018-12-31 | $-786,077 |
Total unrealized appreciation/depreciation of assets | 2018-12-31 | $-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 assets | 2018-12-31 | $-131,665 |
Total of all expenses incurred | 2018-12-31 | $26,052,192 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $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 year | 2018-12-31 | $33,417,742 |
Value of total assets at beginning of year | 2018-12-31 | $32,727,225 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $993,696 |
Total interest from all sources | 2018-12-31 | $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 year | 2018-12-31 | No |
Administrative expenses professional fees incurred | 2018-12-31 | $236,673 |
Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
Value of fidelity bond cover | 2018-12-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $592,721 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $665,229 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $4,133,446 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $3,918,182 |
Other income not declared elsewhere | 2018-12-31 | $324,241 |
Administrative expenses (other) incurred | 2018-12-31 | $299,381 |
Liabilities. Value of operating payables at end of year | 2018-12-31 | $32,751 |
Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $45,604 |
Total non interest bearing cash at end of year | 2018-12-31 | $1,227,650 |
Total non interest bearing cash at beginning of year | 2018-12-31 | $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 appraiser | 2018-12-31 | No |
Value of net income/loss | 2018-12-31 | $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) | 2018-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
Investment advisory and management fees | 2018-12-31 | $96,036 |
Interest earned on other investments | 2018-12-31 | $65,900 |
Income. Interest from US Government securities | 2018-12-31 | $166,097 |
Income. Interest from corporate debt instruments | 2018-12-31 | $271,955 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $7,258,446 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $5,808,110 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $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 benefits | 2018-12-31 | $16,020,472 |
Asset value of US Government securities at end of year | 2018-12-31 | $6,463,413 |
Asset value of US Government securities at beginning of year | 2018-12-31 | $6,005,569 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
Contributions received in cash from employer | 2018-12-31 | $26,766,471 |
Employer contributions (assets) at end of year | 2018-12-31 | $2,278,942 |
Employer contributions (assets) at beginning of year | 2018-12-31 | $2,016,001 |
Income. Dividends from common stock | 2018-12-31 | $97,253 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $9,038,024 |
Asset. Corporate debt instrument debt (other) at end of year | 2018-12-31 | $11,304,912 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2018-12-31 | $12,355,430 |
Contract administrator fees | 2018-12-31 | $361,606 |
Assets. Corporate common stocks other than exployer securities at end of year | 2018-12-31 | $4,291,658 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2018-12-31 | $5,037,899 |
Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $4,521,248 |
Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $4,761,833 |
Did the plan have assets held for investment | 2018-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
Aggregate proceeds on sale of assets | 2018-12-31 | $16,906,066 |
Aggregate carrying amount (costs) on sale of assets | 2018-12-31 | $17,037,731 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
Accountancy firm name | 2018-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2018-12-31 | 562552172 |
2017 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2017 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2017-12-31 | $787,303 |
Total unrealized appreciation/depreciation of assets | 2017-12-31 | $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 assets | 2017-12-31 | $-27,254 |
Total of all expenses incurred | 2017-12-31 | $22,735,863 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $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 year | 2017-12-31 | $32,727,225 |
Value of total assets at beginning of year | 2017-12-31 | $27,056,332 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $940,021 |
Total interest from all sources | 2017-12-31 | $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 year | 2017-12-31 | No |
Administrative expenses professional fees incurred | 2017-12-31 | $246,316 |
Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
Value of fidelity bond cover | 2017-12-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $665,229 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $381,170 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $3,918,182 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $3,629,991 |
Other income not declared elsewhere | 2017-12-31 | $600,085 |
Administrative expenses (other) incurred | 2017-12-31 | $305,249 |
Liabilities. Value of operating payables at end of year | 2017-12-31 | $45,604 |
Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $29,363 |
Total non interest bearing cash at end of year | 2017-12-31 | $838,987 |
Total non interest bearing cash at beginning of year | 2017-12-31 | $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 appraiser | 2017-12-31 | No |
Value of net income/loss | 2017-12-31 | $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) | 2017-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
Investment advisory and management fees | 2017-12-31 | $75,814 |
Interest earned on other investments | 2017-12-31 | $28,757 |
Income. Interest from US Government securities | 2017-12-31 | $81,112 |
Income. Interest from corporate debt instruments | 2017-12-31 | $195,957 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $5,808,110 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $5,236,587 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $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 benefits | 2017-12-31 | $13,000,412 |
Asset value of US Government securities at end of year | 2017-12-31 | $6,005,569 |
Asset value of US Government securities at beginning of year | 2017-12-31 | $4,226,892 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
Contributions received in cash from employer | 2017-12-31 | $24,619,157 |
Employer contributions (assets) at end of year | 2017-12-31 | $2,016,001 |
Employer contributions (assets) at beginning of year | 2017-12-31 | $2,156,691 |
Income. Dividends from common stock | 2017-12-31 | $59,739 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $8,795,430 |
Asset. Corporate debt instrument debt (other) at end of year | 2017-12-31 | $12,355,430 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2017-12-31 | $6,806,526 |
Contract administrator fees | 2017-12-31 | $312,642 |
Assets. Corporate common stocks other than exployer securities at end of year | 2017-12-31 | $5,037,899 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2017-12-31 | $2,887,349 |
Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $4,761,833 |
Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $3,007,312 |
Did the plan have assets held for investment | 2017-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
Aggregate proceeds on sale of assets | 2017-12-31 | $7,279,225 |
Aggregate carrying amount (costs) on sale of assets | 2017-12-31 | $7,306,479 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
Accountancy firm name | 2017-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2017-12-31 | 562552172 |
2016 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2016 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2016-12-31 | $186,691 |
Total unrealized appreciation/depreciation of assets | 2016-12-31 | $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 assets | 2016-12-31 | $135,506 |
Total of all expenses incurred | 2016-12-31 | $19,790,769 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $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 year | 2016-12-31 | $27,056,332 |
Value of total assets at beginning of year | 2016-12-31 | $21,058,792 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $837,681 |
Total interest from all sources | 2016-12-31 | $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 year | 2016-12-31 | No |
Administrative expenses professional fees incurred | 2016-12-31 | $194,956 |
Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
Value of fidelity bond cover | 2016-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $381,170 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $393,006 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-12-31 | $3,629,991 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $3,083,183 |
Other income not declared elsewhere | 2016-12-31 | $255,384 |
Administrative expenses (other) incurred | 2016-12-31 | $303,457 |
Liabilities. Value of operating payables at end of year | 2016-12-31 | $29,363 |
Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $10,991 |
Total non interest bearing cash at end of year | 2016-12-31 | $5,361,117 |
Total non interest bearing cash at beginning of year | 2016-12-31 | $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 appraiser | 2016-12-31 | No |
Value of net income/loss | 2016-12-31 | $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) | 2016-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
Investment advisory and management fees | 2016-12-31 | $55,214 |
Interest earned on other investments | 2016-12-31 | $8,684 |
Income. Interest from US Government securities | 2016-12-31 | $81,783 |
Income. Interest from corporate debt instruments | 2016-12-31 | $186,391 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $5,236,587 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $4,450,803 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $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 benefits | 2016-12-31 | $12,345,686 |
Asset value of US Government securities at end of year | 2016-12-31 | $4,226,892 |
Asset value of US Government securities at beginning of year | 2016-12-31 | $5,097,495 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
Contributions received in cash from employer | 2016-12-31 | $24,270,225 |
Employer contributions (assets) at end of year | 2016-12-31 | $2,156,691 |
Employer contributions (assets) at beginning of year | 2016-12-31 | $1,954,443 |
Income. Dividends from common stock | 2016-12-31 | $47,072 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $6,607,402 |
Asset. Corporate debt instrument debt (other) at end of year | 2016-12-31 | $6,806,526 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2016-12-31 | $3,828,348 |
Contract administrator fees | 2016-12-31 | $284,054 |
Assets. Corporate common stocks other than exployer securities at end of year | 2016-12-31 | $2,887,349 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2016-12-31 | $2,295,698 |
Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $3,007,312 |
Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $2,956,637 |
Did the plan have assets held for investment | 2016-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
Aggregate proceeds on sale of assets | 2016-12-31 | $11,311,095 |
Aggregate carrying amount (costs) on sale of assets | 2016-12-31 | $11,175,589 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
Accountancy firm name | 2016-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2016-12-31 | 562552172 |
2015 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2015 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2015-12-31 | $-217,677 |
Total unrealized appreciation/depreciation of assets | 2015-12-31 | $-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 assets | 2015-12-31 | $-125,732 |
Total of all expenses incurred | 2015-12-31 | $19,132,529 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $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 year | 2015-12-31 | $21,058,792 |
Value of total assets at beginning of year | 2015-12-31 | $19,650,735 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $794,032 |
Total interest from all sources | 2015-12-31 | $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 year | 2015-12-31 | No |
Administrative expenses professional fees incurred | 2015-12-31 | $164,937 |
Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
Value of fidelity bond cover | 2015-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $393,006 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $665,411 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $3,083,183 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $2,725,173 |
Other income not declared elsewhere | 2015-12-31 | $154,389 |
Administrative expenses (other) incurred | 2015-12-31 | $329,087 |
Liabilities. Value of operating payables at end of year | 2015-12-31 | $10,991 |
Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $26,246 |
Total non interest bearing cash at end of year | 2015-12-31 | $3,038,999 |
Total non interest bearing cash at beginning of year | 2015-12-31 | $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 appraiser | 2015-12-31 | No |
Value of net income/loss | 2015-12-31 | $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) | 2015-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
Investment advisory and management fees | 2015-12-31 | $51,575 |
Interest earned on other investments | 2015-12-31 | $1,476 |
Income. Interest from US Government securities | 2015-12-31 | $162,618 |
Income. Interest from corporate debt instruments | 2015-12-31 | $156,221 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $4,450,803 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $2,566,720 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $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 benefits | 2015-12-31 | $12,405,974 |
Asset value of US Government securities at end of year | 2015-12-31 | $5,097,495 |
Asset value of US Government securities at beginning of year | 2015-12-31 | $3,976,972 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
Contributions received in cash from employer | 2015-12-31 | $20,335,366 |
Employer contributions (assets) at end of year | 2015-12-31 | $1,954,443 |
Employer contributions (assets) at beginning of year | 2015-12-31 | $1,734,900 |
Income. Dividends from common stock | 2015-12-31 | $43,142 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $5,932,523 |
Asset. Corporate debt instrument debt (other) at end of year | 2015-12-31 | $3,828,348 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2015-12-31 | $4,802,677 |
Contract administrator fees | 2015-12-31 | $248,433 |
Assets. Corporate common stocks other than exployer securities at end of year | 2015-12-31 | $2,295,698 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2015-12-31 | $2,393,276 |
Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $2,956,637 |
Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $3,268,761 |
Did the plan have assets held for investment | 2015-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
Aggregate proceeds on sale of assets | 2015-12-31 | $5,332,884 |
Aggregate carrying amount (costs) on sale of assets | 2015-12-31 | $5,458,616 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
Accountancy firm name | 2015-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2015-12-31 | 562552172 |
2014 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2014 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2014-12-31 | $166,544 |
Total unrealized appreciation/depreciation of assets | 2014-12-31 | $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 assets | 2014-12-31 | $-59,041 |
Total of all expenses incurred | 2014-12-31 | $19,903,294 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $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 year | 2014-12-31 | $19,650,735 |
Value of total assets at beginning of year | 2014-12-31 | $19,134,472 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $638,146 |
Total interest from all sources | 2014-12-31 | $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 year | 2014-12-31 | No |
Administrative expenses professional fees incurred | 2014-12-31 | $126,289 |
Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
Value of fidelity bond cover | 2014-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
Assets. Other investments not covered elsewhere at beginning of year | 2014-12-31 | $634,187 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $665,411 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $116,726 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $2,725,173 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $2,525,364 |
Other income not declared elsewhere | 2014-12-31 | $823,632 |
Administrative expenses (other) incurred | 2014-12-31 | $202,106 |
Liabilities. Value of operating payables at end of year | 2014-12-31 | $26,246 |
Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $25,473 |
Total non interest bearing cash at end of year | 2014-12-31 | $3,510,779 |
Total non interest bearing cash at beginning of year | 2014-12-31 | $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 appraiser | 2014-12-31 | No |
Value of net income/loss | 2014-12-31 | $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) | 2014-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
Investment advisory and management fees | 2014-12-31 | $58,167 |
Interest earned on other investments | 2014-12-31 | $23,074 |
Income. Interest from US Government securities | 2014-12-31 | $163,777 |
Income. Interest from corporate debt instruments | 2014-12-31 | $88,899 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $2,566,720 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $2,501,521 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $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 benefits | 2014-12-31 | $12,824,053 |
Asset value of US Government securities at end of year | 2014-12-31 | $3,976,972 |
Asset value of US Government securities at beginning of year | 2014-12-31 | $4,143,377 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
Contributions received in cash from employer | 2014-12-31 | $19,390,259 |
Employer contributions (assets) at end of year | 2014-12-31 | $1,734,900 |
Employer contributions (assets) at beginning of year | 2014-12-31 | $1,667,957 |
Income. Dividends from common stock | 2014-12-31 | $34,624 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $6,441,095 |
Asset. Corporate debt instrument debt (other) at end of year | 2014-12-31 | $4,802,677 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2014-12-31 | $2,546,591 |
Contract administrator fees | 2014-12-31 | $251,584 |
Assets. Corporate common stocks other than exployer securities at end of year | 2014-12-31 | $2,393,276 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2014-12-31 | $1,916,134 |
Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $3,268,761 |
Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $3,681,712 |
Did the plan have assets held for investment | 2014-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
Aggregate proceeds on sale of assets | 2014-12-31 | $20,201,793 |
Aggregate carrying amount (costs) on sale of assets | 2014-12-31 | $20,260,834 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
Accountancy firm name | 2014-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2014-12-31 | 562552172 |
2013 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2013 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2013-12-31 | $310,404 |
Total unrealized appreciation/depreciation of assets | 2013-12-31 | $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 assets | 2013-12-31 | $-167,323 |
Total of all expenses incurred | 2013-12-31 | $18,456,860 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $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 year | 2013-12-31 | $19,134,472 |
Value of total assets at beginning of year | 2013-12-31 | $16,050,725 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $663,497 |
Total interest from all sources | 2013-12-31 | $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 year | 2013-12-31 | No |
Administrative expenses professional fees incurred | 2013-12-31 | $139,041 |
Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
Value of fidelity bond cover | 2013-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
Assets. Other investments not covered elsewhere at end of year | 2013-12-31 | $634,187 |
Assets. Other investments not covered elsewhere at beginning of year | 2013-12-31 | $645,282 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $116,726 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $112,414 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $2,525,364 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $2,110,055 |
Other income not declared elsewhere | 2013-12-31 | $180,439 |
Administrative expenses (other) incurred | 2013-12-31 | $209,530 |
Liabilities. Value of operating payables at end of year | 2013-12-31 | $25,473 |
Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $28,299 |
Total non interest bearing cash at end of year | 2013-12-31 | $5,607,979 |
Total non interest bearing cash at beginning of year | 2013-12-31 | $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 appraiser | 2013-12-31 | No |
Value of net income/loss | 2013-12-31 | $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) | 2013-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
Investment advisory and management fees | 2013-12-31 | $56,068 |
Interest earned on other investments | 2013-12-31 | $22,985 |
Income. Interest from US Government securities | 2013-12-31 | $159,144 |
Income. Interest from corporate debt instruments | 2013-12-31 | $90,122 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $2,501,521 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $2,907,633 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $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 benefits | 2013-12-31 | $11,695,501 |
Asset value of US Government securities at end of year | 2013-12-31 | $4,143,377 |
Asset value of US Government securities at beginning of year | 2013-12-31 | $4,834,080 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
Contributions received in cash from employer | 2013-12-31 | $19,509,276 |
Employer contributions (assets) at end of year | 2013-12-31 | $1,667,957 |
Employer contributions (assets) at beginning of year | 2013-12-31 | $1,559,282 |
Income. Dividends from common stock | 2013-12-31 | $30,604 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $6,097,862 |
Asset. Corporate debt instrument debt (other) at end of year | 2013-12-31 | $2,546,591 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2013-12-31 | $1,953,015 |
Contract administrator fees | 2013-12-31 | $258,858 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
Assets. Corporate common stocks other than exployer securities at end of year | 2013-12-31 | $1,916,134 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2013-12-31 | $1,374,257 |
Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $3,681,712 |
Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $2,689,759 |
Did the plan have assets held for investment | 2013-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
Aggregate proceeds on sale of assets | 2013-12-31 | $15,632,726 |
Aggregate carrying amount (costs) on sale of assets | 2013-12-31 | $15,800,049 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
Accountancy firm name | 2013-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2013-12-31 | 562552172 |
2012 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2012 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2012-12-31 | $161,651 |
Total unrealized appreciation/depreciation of assets | 2012-12-31 | $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 assets | 2012-12-31 | $-50,638 |
Total of all expenses incurred | 2012-12-31 | $15,840,589 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $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 year | 2012-12-31 | $16,050,725 |
Value of total assets at beginning of year | 2012-12-31 | $13,820,710 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $646,831 |
Total interest from all sources | 2012-12-31 | $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 year | 2012-12-31 | No |
Administrative expenses professional fees incurred | 2012-12-31 | $154,132 |
Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
Value of fidelity bond cover | 2012-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
Assets. Other investments not covered elsewhere at end of year | 2012-12-31 | $645,282 |
Assets. Other investments not covered elsewhere at beginning of year | 2012-12-31 | $287,131 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $112,414 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $75,838 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $2,110,055 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $1,764,471 |
Other income not declared elsewhere | 2012-12-31 | $145,007 |
Administrative expenses (other) incurred | 2012-12-31 | $171,862 |
Liabilities. Value of operating payables at end of year | 2012-12-31 | $28,299 |
Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $26,002 |
Total non interest bearing cash at end of year | 2012-12-31 | $2,664,762 |
Total non interest bearing cash at beginning of year | 2012-12-31 | $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 appraiser | 2012-12-31 | No |
Value of net income/loss | 2012-12-31 | $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) | 2012-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
Investment advisory and management fees | 2012-12-31 | $54,516 |
Interest earned on other investments | 2012-12-31 | $33,435 |
Income. Interest from US Government securities | 2012-12-31 | $152,315 |
Income. Interest from corporate debt instruments | 2012-12-31 | $77,923 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $2,907,633 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $3,052,779 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $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 benefits | 2012-12-31 | $10,433,705 |
Asset value of US Government securities at end of year | 2012-12-31 | $4,834,080 |
Asset value of US Government securities at beginning of year | 2012-12-31 | $4,241,207 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
Contributions received in cash from employer | 2012-12-31 | $17,400,997 |
Employer contributions (assets) at end of year | 2012-12-31 | $1,559,282 |
Employer contributions (assets) at beginning of year | 2012-12-31 | $1,403,386 |
Income. Dividends from common stock | 2012-12-31 | $27,148 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $4,760,053 |
Asset. Corporate debt instrument debt (other) at end of year | 2012-12-31 | $1,953,015 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2012-12-31 | $2,733,785 |
Contract administrator fees | 2012-12-31 | $266,321 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
Assets. Corporate common stocks other than exployer securities at end of year | 2012-12-31 | $1,374,257 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2012-12-31 | $1,176,787 |
Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $2,689,759 |
Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $2,915,520 |
Did the plan have assets held for investment | 2012-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
Aggregate proceeds on sale of assets | 2012-12-31 | $12,746,921 |
Aggregate carrying amount (costs) on sale of assets | 2012-12-31 | $12,797,559 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
Accountancy firm name | 2012-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2012-12-31 | 562552172 |
2011 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2011 401k financial data |
---|
Unrealized appreciation/depreciation of real estate assets | 2011-12-31 | $-45,165 |
Total unrealized appreciation/depreciation of assets | 2011-12-31 | $-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 assets | 2011-12-31 | $78,294 |
Total of all expenses incurred | 2011-12-31 | $14,791,697 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $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 year | 2011-12-31 | $13,820,710 |
Value of total assets at beginning of year | 2011-12-31 | $12,083,476 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $654,437 |
Total interest from all sources | 2011-12-31 | $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 year | 2011-12-31 | No |
Administrative expenses professional fees incurred | 2011-12-31 | $158,201 |
Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
Value of fidelity bond cover | 2011-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
Assets. Other investments not covered elsewhere at end of year | 2011-12-31 | $287,131 |
Assets. Other investments not covered elsewhere at beginning of year | 2011-12-31 | $221,287 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $75,838 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $60,256 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-12-31 | $1,764,471 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-12-31 | $1,479,197 |
Administrative expenses (other) incurred | 2011-12-31 | $191,962 |
Liabilities. Value of operating payables at end of year | 2011-12-31 | $26,002 |
Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $19,172 |
Total non interest bearing cash at end of year | 2011-12-31 | $849,797 |
Total non interest bearing cash at beginning of year | 2011-12-31 | $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 appraiser | 2011-12-31 | No |
Value of net income/loss | 2011-12-31 | $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) | 2011-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
Investment advisory and management fees | 2011-12-31 | $47,479 |
Interest earned on other investments | 2011-12-31 | $7,607 |
Income. Interest from US Government securities | 2011-12-31 | $120,703 |
Income. Interest from corporate debt instruments | 2011-12-31 | $100,760 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $3,052,779 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $2,274,106 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $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 benefits | 2011-12-31 | $9,373,366 |
Asset value of US Government securities at end of year | 2011-12-31 | $4,241,207 |
Asset value of US Government securities at beginning of year | 2011-12-31 | $2,755,063 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
Contributions received in cash from employer | 2011-12-31 | $15,724,695 |
Employer contributions (assets) at end of year | 2011-12-31 | $1,403,386 |
Employer contributions (assets) at beginning of year | 2011-12-31 | $1,336,347 |
Income. Dividends from common stock | 2011-12-31 | $20,701 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $4,763,894 |
Asset. Corporate debt instrument debt (other) at end of year | 2011-12-31 | $2,733,785 |
Asset. Corporate debt instrument debt (other) at beginning of year | 2011-12-31 | $1,813,450 |
Contract administrator fees | 2011-12-31 | $256,795 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
Assets. Corporate common stocks other than exployer securities at end of year | 2011-12-31 | $1,176,787 |
Assets. Corporate common stocks other than exployer securities at beginning of year | 2011-12-31 | $910,008 |
Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $2,915,520 |
Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $2,688,190 |
Did the plan have assets held for investment | 2011-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
Aggregate proceeds on sale of assets | 2011-12-31 | $12,452,240 |
Aggregate carrying amount (costs) on sale of assets | 2011-12-31 | $12,373,946 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
Accountancy firm name | 2011-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2011-12-31 | 562552172 |
2010 : SAN MATEO HOTEL EMPLOYEES & RESTAURANT EMPLOYEES WELFARE FUND 2010 401k financial data |
---|
Unrealized appreciation/depreciation of other (non real estate) assets | 2010-12-31 | $9,662 |
Total unrealized appreciation/depreciation of assets | 2010-12-31 | $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 assets | 2010-12-31 | $-30,071 |
Total of all expenses incurred | 2010-12-31 | $12,698,555 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $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 year | 2010-12-31 | $12,083,476 |
Value of total assets at beginning of year | 2010-12-31 | $9,021,128 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $661,182 |
Total interest from all sources | 2010-12-31 | $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 year | 2010-12-31 | No |
Administrative expenses professional fees incurred | 2010-12-31 | $119,673 |
Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
Value of fidelity bond cover | 2010-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
Assets. Other investments not covered elsewhere at end of year | 2010-12-31 | $221,287 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $60,256 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $31,121 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $1,479,197 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $1,205,025 |
Other income not declared elsewhere | 2010-12-31 | $226,867 |
Administrative expenses (other) incurred | 2010-12-31 | $251,812 |
Liabilities. Value of operating payables at end of year | 2010-12-31 | $19,172 |
Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $18,742 |
Total non interest bearing cash at end of year | 2010-12-31 | $2,712,959 |
Total non interest bearing cash at beginning of year | 2010-12-31 | $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 appraiser | 2010-12-31 | No |
Value of net income/loss | 2010-12-31 | $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) | 2010-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
Investment advisory and management fees | 2010-12-31 | $28,038 |
Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2010-12-31 | $5,248,336 |
Interest earned on other investments | 2010-12-31 | $285 |
Income. Interest from US Government securities | 2010-12-31 | $9,704 |
Income. Interest from corporate debt instruments | 2010-12-31 | $6,707 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $2,274,106 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $1,400,918 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $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 benefits | 2010-12-31 | $7,981,681 |
Asset value of US Government securities at end of year | 2010-12-31 | $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 assets | 2010-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
Contributions received in cash from employer | 2010-12-31 | $15,039,877 |
Employer contributions (assets) at end of year | 2010-12-31 | $1,336,347 |
Employer contributions (assets) at beginning of year | 2010-12-31 | $1,133,249 |
Income. Dividends from common stock | 2010-12-31 | $473 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $4,055,692 |
Asset. Corporate debt instrument debt (other) at end of year | 2010-12-31 | $1,813,450 |
Contract administrator fees | 2010-12-31 | $261,659 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
Assets. Corporate common stocks other than exployer securities at end of year | 2010-12-31 | $910,008 |
Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $2,688,190 |
Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $2,992,166 |
Did the plan have assets held for investment | 2010-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
Aggregate proceeds on sale of assets | 2010-12-31 | $2,285,972 |
Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $2,316,043 |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
Accountancy firm name | 2010-12-31 | INEICH & COMPANY, LLP |
Accountancy firm EIN | 2010-12-31 | 562552172 |
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1840 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 4 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | HCL36264 |
Policy instance | 3 |
Insurance contract or identification number | HCL36264 | Number of Individuals Covered | 739 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $44,872 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $897,446 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $44,872 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1853 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2536 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 6 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 1313 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1593 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1579 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 Covered | 628 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $28,170 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $563,404 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,170 | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 5 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 6 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 847 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2249 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2221 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1501 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | 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 number | SL10407 |
Policy instance | 3 |
Insurance contract or identification number | SL10407 | Number of Individuals Covered | 595 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $77,889 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 Broker | USD $77,889 | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 8 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1557 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 6 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 915 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2579 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 2047 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | SE3E50008 |
Policy instance | 3 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 1029 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $60,195 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 Broker | USD $60,195 | Insurance broker organization code? | 3 |
|
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 2197 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 8 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 6 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 1312 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2419 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 6 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 1190 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1945 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 9 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 3 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 932 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $56,120 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 Broker | USD $56,120 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1925 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 6 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 1128 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1859 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 11 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 3 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 971 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $51,237 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 Broker | USD $51,237 | Insurance broker organization code? | 3 | Insurance broker name | STOP LOSS INSURANCE SERVICES, INC. |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1850 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2024 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 2018 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1592 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 3 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 697 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $42,896 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $857,921 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,896 | Insurance broker organization code? | 3 | Insurance broker name | STOP LOSS INSURANCE SERVICES, INC. |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 11 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1594 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 3 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 775 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 1960 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 401473 |
Policy instance | 4 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 11 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1588 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1534 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1608 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 5 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1344 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 1987 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 3 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 654 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $53,249 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $507,130 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,428 | Insurance broker organization code? | 3 | Insurance broker name | STOP LOSS INSURANCE SERVICES-NC |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0711888 |
Policy instance | 4 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 1105 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014 |
Policy instance | 1 |
Insurance contract or identification number | 8014 | Number of Individuals Covered | 1882 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | G8023 |
Policy instance | 6 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1464 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 5 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 688 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 401473 |
Policy instance | 3 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 18 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1553 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 4 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 571 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $44,798 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $426,646 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,599 | Insurance broker organization code? | 3 | Insurance broker name | STOP LOSS INSURANCE SERVICES-NC |
|
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | G8023 |
Policy instance | 6 |
Insurance contract or identification number | G8023 | Number of Individuals Covered | 1260 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 5 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 959 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 4 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 588 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $46,548 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 number | 401473 |
Policy instance | 3 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 19 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1491 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014-0000 |
Policy instance | 1 |
Insurance contract or identification number | 8014-0000 | Number of Individuals Covered | 1890 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | SE3E50008 |
Policy instance | 4 |
Insurance contract or identification number | SE3E50008 | Number of Individuals Covered | 624 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $26,171 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SPECIFIC 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 Carrier | USD $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 number | 401473 |
Policy instance | 3 |
Insurance contract or identification number | 401473 | Number of Individuals Covered | 20 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 00410000 |
Policy instance | 2 |
Insurance contract or identification number | 00410000 | Number of Individuals Covered | 1451 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 8014-0000 |
Policy instance | 1 |
Insurance contract or identification number | 8014-0000 | Number of Individuals Covered | 1659 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0711888 |
Policy instance | 5 |
Insurance contract or identification number | 0711888 | Number of Individuals Covered | 1123 | Insurance policy start date | 2009-07-01 | Insurance policy end date | 2010-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $239,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|