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U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 401k Plan overview

Plan NameU.A. LOCAL NO. 159 HEALTH & WELFARE PLAN
Plan identification number 502

U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

BOARD OF TRUSTEES OF U.A. LOCAL NO. 159 HEALTH AND WELFARE TRUST FUND has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES OF U.A. LOCAL NO. 159 HEALTH AND WELFARE TRUST FUND
Employer identification number (EIN):946430804
NAIC Classification:238220
NAIC Description:Plumbing, Heating, and Air-Conditioning Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-07-01NICK GOODWIN2023-04-02 ALEX HALL2023-04-02
5022020-07-01
5022019-07-01
5022018-07-01
5022017-07-01
5022016-07-01ROBERT SEWELL ALEX HALL2018-03-12
5022015-07-01ROBERT SEWELL RONALD MITCHELL2017-03-28
5022014-07-01ARAM HODESS NORMAN LESCURE2016-03-23
5022013-07-01ARAM HODESS NORMAN LESCURE2015-04-03
5022012-07-01ARAM HODESS NORMAN LESCURE2014-04-10
5022011-07-01ARAM HODESS NORMAN LESCURE2013-04-05
5022009-07-01ARAM HODESS NORMAN LESCURE2011-04-13

Plan Statistics for U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN

401k plan membership statisitcs for U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN

Measure Date Value
2021: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01374
Total number of active participants reported on line 7a of the Form 55002021-07-01244
Number of retired or separated participants receiving benefits2021-07-01124
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01368
Number of employers contributing to the scheme2021-07-0154
2020: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01440
Total number of active participants reported on line 7a of the Form 55002020-07-01245
Number of retired or separated participants receiving benefits2020-07-01129
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01374
Number of employers contributing to the scheme2020-07-0150
2019: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01435
Total number of active participants reported on line 7a of the Form 55002019-07-01279
Number of retired or separated participants receiving benefits2019-07-01134
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01413
Number of employers contributing to the scheme2019-07-0159
2018: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01430
Total number of active participants reported on line 7a of the Form 55002018-07-01299
Number of retired or separated participants receiving benefits2018-07-01136
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01435
Number of employers contributing to the scheme2018-07-0159
2017: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01370
Total number of active participants reported on line 7a of the Form 55002017-07-01286
Number of retired or separated participants receiving benefits2017-07-01144
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01430
Number of employers contributing to the scheme2017-07-0157
2016: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01371
Total number of active participants reported on line 7a of the Form 55002016-07-01231
Number of retired or separated participants receiving benefits2016-07-01139
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01370
Number of employers contributing to the scheme2016-07-0152
2015: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01336
Total number of active participants reported on line 7a of the Form 55002015-07-01239
Number of retired or separated participants receiving benefits2015-07-01132
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01371
Number of employers contributing to the scheme2015-07-0155
2014: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01322
Total number of active participants reported on line 7a of the Form 55002014-07-01208
Number of retired or separated participants receiving benefits2014-07-01128
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01336
Number of employers contributing to the scheme2014-07-0158
2013: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01309
Total number of active participants reported on line 7a of the Form 55002013-07-01193
Number of retired or separated participants receiving benefits2013-07-01129
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01322
Number of employers contributing to the scheme2013-07-0156
2012: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01331
Total number of active participants reported on line 7a of the Form 55002012-07-01194
Number of retired or separated participants receiving benefits2012-07-01115
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01309
Number of employers contributing to the scheme2012-07-0140
2011: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01323
Total number of active participants reported on line 7a of the Form 55002011-07-01212
Number of retired or separated participants receiving benefits2011-07-01119
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01331
Number of employers contributing to the scheme2011-07-0140
2009: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01473
Total number of active participants reported on line 7a of the Form 55002009-07-01231
Number of retired or separated participants receiving benefits2009-07-01119
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01350
Number of employers contributing to the scheme2009-07-0145

Financial Data on U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN

Measure Date Value
2022 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$131,435
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$143,069
Total income from all sources (including contributions)2022-06-30$5,913,944
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$6,901,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$6,459,954
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$6,817,122
Value of total assets at end of year2022-06-30$10,473,868
Value of total assets at beginning of year2022-06-30$11,472,796
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$441,284
Total interest from all sources2022-06-30$376
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$255,359
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2022-06-30$255,359
Administrative expenses professional fees incurred2022-06-30$167,137
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$1,100,000
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$360,370
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-06-30$25,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-06-30$12,000
Other income not declared elsewhere2022-06-30$27,080
Administrative expenses (other) incurred2022-06-30$43,547
Liabilities. Value of operating payables at end of year2022-06-30$39,435
Liabilities. Value of operating payables at beginning of year2022-06-30$55,069
Total non interest bearing cash at end of year2022-06-30$703,615
Total non interest bearing cash at beginning of year2022-06-30$855,053
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-987,294
Value of net assets at end of year (total assets less liabilities)2022-06-30$10,342,433
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$11,329,727
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Investment advisory and management fees2022-06-30$8,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$7,389,303
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$8,319,937
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-06-30$1,754,950
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-06-30$1,573,806
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-06-30$1,573,806
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$376
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$5,945,418
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-06-30$-1,185,993
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$6,456,752
Employer contributions (assets) at end of year2022-06-30$626,000
Employer contributions (assets) at beginning of year2022-06-30$724,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$514,536
Contract administrator fees2022-06-30$222,600
Liabilities. Value of benefit claims payable at end of year2022-06-30$67,000
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$76,000
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30WITHUMSMITH+BROWN, PC
Accountancy firm EIN2022-06-30222027092
2021 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$143,069
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$112,430
Total income from all sources (including contributions)2021-06-30$7,937,325
Total of all expenses incurred2021-06-30$6,999,427
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$6,578,116
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$7,169,630
Value of total assets at end of year2021-06-30$11,472,796
Value of total assets at beginning of year2021-06-30$10,504,259
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$421,311
Total interest from all sources2021-06-30$153
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$247,077
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2021-06-30$247,077
Administrative expenses professional fees incurred2021-06-30$156,040
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$1,100,000
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$379,774
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-06-30$12,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-06-30$8,000
Other income not declared elsewhere2021-06-30$16,061
Administrative expenses (other) incurred2021-06-30$34,672
Liabilities. Value of operating payables at end of year2021-06-30$55,069
Liabilities. Value of operating payables at beginning of year2021-06-30$24,430
Total non interest bearing cash at end of year2021-06-30$855,053
Total non interest bearing cash at beginning of year2021-06-30$728,098
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$937,898
Value of net assets at end of year (total assets less liabilities)2021-06-30$11,329,727
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$10,391,829
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Investment advisory and management fees2021-06-30$7,999
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-06-30$8,319,937
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-06-30$7,568,456
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-06-30$1,573,806
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-06-30$1,500,205
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-06-30$1,500,205
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$153
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$6,123,526
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-06-30$504,404
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30Yes
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$6,789,856
Employer contributions (assets) at end of year2021-06-30$724,000
Employer contributions (assets) at beginning of year2021-06-30$707,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$454,590
Contract administrator fees2021-06-30$222,600
Liabilities. Value of benefit claims payable at end of year2021-06-30$76,000
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$80,000
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Unqualified
Accountancy firm name2021-06-30WITHUMSMITH+BROWN, PC
Accountancy firm EIN2021-06-30222027092
2020 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$112,430
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$163,824
Total income from all sources (including contributions)2020-06-30$7,559,461
Total of all expenses incurred2020-06-30$7,678,654
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$7,260,114
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$7,367,693
Value of total assets at end of year2020-06-30$10,504,259
Value of total assets at beginning of year2020-06-30$10,674,846
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$418,540
Total interest from all sources2020-06-30$345
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$315,700
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2020-06-30$315,700
Administrative expenses professional fees incurred2020-06-30$148,518
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$1,100,000
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$377,299
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-06-30$8,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-06-30$34,000
Administrative expenses (other) incurred2020-06-30$39,422
Liabilities. Value of operating payables at end of year2020-06-30$24,430
Liabilities. Value of operating payables at beginning of year2020-06-30$45,824
Total non interest bearing cash at end of year2020-06-30$728,098
Total non interest bearing cash at beginning of year2020-06-30$959,148
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$-119,193
Value of net assets at end of year (total assets less liabilities)2020-06-30$10,391,829
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$10,511,022
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Investment advisory and management fees2020-06-30$8,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-06-30$7,568,456
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-06-30$7,377,033
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-06-30$1,500,205
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-06-30$1,573,665
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-06-30$1,573,665
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-06-30$345
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$6,798,271
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-06-30$-124,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30No
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$6,990,394
Employer contributions (assets) at end of year2020-06-30$707,500
Employer contributions (assets) at beginning of year2020-06-30$765,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$461,843
Contract administrator fees2020-06-30$222,600
Liabilities. Value of benefit claims payable at end of year2020-06-30$80,000
Liabilities. Value of benefit claims payable at beginning of year2020-06-30$84,000
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30No
Opinion of an independent qualified public accountant for this plan2020-06-30Unqualified
Accountancy firm name2020-06-30LINDQUIST LLP
Accountancy firm EIN2020-06-30522385296
2019 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$163,824
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$185,320
Total income from all sources (including contributions)2019-06-30$8,856,309
Total of all expenses incurred2019-06-30$7,803,318
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$7,388,401
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$8,408,173
Value of total assets at end of year2019-06-30$10,674,846
Value of total assets at beginning of year2019-06-30$9,643,351
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$414,917
Total interest from all sources2019-06-30$286
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$297,134
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2019-06-30$297,134
Administrative expenses professional fees incurred2019-06-30$153,035
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$1,100,000
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$359,510
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-06-30$34,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-06-30$35,000
Administrative expenses (other) incurred2019-06-30$31,282
Liabilities. Value of operating payables at end of year2019-06-30$45,824
Liabilities. Value of operating payables at beginning of year2019-06-30$66,320
Total non interest bearing cash at end of year2019-06-30$959,148
Total non interest bearing cash at beginning of year2019-06-30$986,031
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$1,052,991
Value of net assets at end of year (total assets less liabilities)2019-06-30$10,511,022
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$9,458,031
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Investment advisory and management fees2019-06-30$8,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$7,377,033
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$6,929,183
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-06-30$1,573,665
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-06-30$876,837
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-06-30$876,837
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-06-30$286
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$6,893,869
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-06-30$150,716
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$8,048,663
Employer contributions (assets) at end of year2019-06-30$765,000
Employer contributions (assets) at beginning of year2019-06-30$851,300
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$494,532
Contract administrator fees2019-06-30$222,600
Liabilities. Value of benefit claims payable at end of year2019-06-30$84,000
Liabilities. Value of benefit claims payable at beginning of year2019-06-30$84,000
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30No
Opinion of an independent qualified public accountant for this plan2019-06-30Unqualified
Accountancy firm name2019-06-30LINDQUIST LLP
Accountancy firm EIN2019-06-30522385296
2018 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$185,320
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$107,731
Total income from all sources (including contributions)2018-06-30$7,961,630
Total of all expenses incurred2018-06-30$6,718,922
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$6,349,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$7,814,298
Value of total assets at end of year2018-06-30$9,643,351
Value of total assets at beginning of year2018-06-30$8,323,054
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$369,444
Total interest from all sources2018-06-30$107
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$275,715
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2018-06-30$275,715
Administrative expenses professional fees incurred2018-06-30$112,242
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$1,100,000
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$362,479
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-06-30$35,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-06-30$14,200
Administrative expenses (other) incurred2018-06-30$28,602
Liabilities. Value of operating payables at end of year2018-06-30$66,320
Liabilities. Value of operating payables at beginning of year2018-06-30$31,531
Total non interest bearing cash at end of year2018-06-30$986,031
Total non interest bearing cash at beginning of year2018-06-30$669,520
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$1,242,708
Value of net assets at end of year (total assets less liabilities)2018-06-30$9,458,031
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$8,215,323
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Investment advisory and management fees2018-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-06-30$6,929,183
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-06-30$6,781,957
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-06-30$876,837
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-06-30$288,577
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-06-30$288,577
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-06-30$107
Expenses. Payments to insurance carriers foe the provision of benefits2018-06-30$5,960,402
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-06-30$-128,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30No
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Contributions received in cash from employer2018-06-30$7,451,819
Employer contributions (assets) at end of year2018-06-30$851,300
Employer contributions (assets) at beginning of year2018-06-30$583,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-06-30$389,076
Contract administrator fees2018-06-30$222,600
Liabilities. Value of benefit claims payable at end of year2018-06-30$84,000
Liabilities. Value of benefit claims payable at beginning of year2018-06-30$62,000
Did the plan have assets held for investment2018-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30No
Opinion of an independent qualified public accountant for this plan2018-06-30Unqualified
Accountancy firm name2018-06-30LINDQUIST LLP
Accountancy firm EIN2018-06-30522385296
2017 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$107,731
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$108,276
Total income from all sources (including contributions)2017-06-30$6,264,254
Total of all expenses incurred2017-06-30$6,163,374
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$5,792,874
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$5,903,229
Value of total assets at end of year2017-06-30$8,323,054
Value of total assets at beginning of year2017-06-30$8,222,719
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$370,500
Total interest from all sources2017-06-30$137
Total dividends received (eg from common stock, registered investment company shares)2017-06-30$252,331
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2017-06-30$252,331
Administrative expenses professional fees incurred2017-06-30$114,446
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$1,100,000
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$390,101
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-06-30$14,200
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-06-30$20,400
Administrative expenses (other) incurred2017-06-30$27,454
Liabilities. Value of operating payables at end of year2017-06-30$31,531
Liabilities. Value of operating payables at beginning of year2017-06-30$31,876
Total non interest bearing cash at end of year2017-06-30$669,520
Total non interest bearing cash at beginning of year2017-06-30$500,877
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$100,880
Value of net assets at end of year (total assets less liabilities)2017-06-30$8,215,323
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$8,114,443
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Investment advisory and management fees2017-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-06-30$6,781,957
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$5,421,070
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-06-30$288,577
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-06-30$1,614,772
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-06-30$1,614,772
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-06-30$137
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$5,486,242
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-06-30$108,557
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30Yes
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$5,513,128
Employer contributions (assets) at end of year2017-06-30$583,000
Employer contributions (assets) at beginning of year2017-06-30$686,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$306,632
Contract administrator fees2017-06-30$222,600
Liabilities. Value of benefit claims payable at end of year2017-06-30$62,000
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$56,000
Did the plan have assets held for investment2017-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30LINDQUIST LLP
Accountancy firm EIN2017-06-30522385296
2016 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$108,276
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$104,361
Total income from all sources (including contributions)2016-06-30$6,413,312
Total of all expenses incurred2016-06-30$5,765,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$5,395,553
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$6,272,024
Value of total assets at end of year2016-06-30$8,222,719
Value of total assets at beginning of year2016-06-30$7,571,318
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$370,273
Total interest from all sources2016-06-30$301
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$242,568
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2016-06-30$242,568
Administrative expenses professional fees incurred2016-06-30$113,238
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$1,100,000
If this is an individual account plan, was there a blackout period2016-06-30No
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$370,449
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$10,500
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-06-30$20,400
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-06-30$9,000
Administrative expenses (other) incurred2016-06-30$28,435
Liabilities. Value of operating payables at end of year2016-06-30$31,876
Liabilities. Value of operating payables at beginning of year2016-06-30$26,461
Total non interest bearing cash at end of year2016-06-30$500,877
Total non interest bearing cash at beginning of year2016-06-30$471,023
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$647,486
Value of net assets at end of year (total assets less liabilities)2016-06-30$8,114,443
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$7,466,957
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Investment advisory and management fees2016-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$5,421,070
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$5,280,082
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-06-30$1,614,772
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-06-30$1,277,713
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-06-30$1,277,713
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-06-30$301
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$5,233,933
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-06-30$-101,581
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30Yes
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$5,901,575
Employer contributions (assets) at end of year2016-06-30$686,000
Employer contributions (assets) at beginning of year2016-06-30$532,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$161,620
Contract administrator fees2016-06-30$222,600
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-06-30No
Liabilities. Value of benefit claims payable at end of year2016-06-30$56,000
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$68,900
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30LINDQUIST LLP
Accountancy firm EIN2016-06-30522385296
2015 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$104,361
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$106,302
Total income from all sources (including contributions)2015-06-30$5,339,495
Total of all expenses incurred2015-06-30$5,219,972
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$4,846,991
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$5,285,118
Value of total assets at end of year2015-06-30$7,571,318
Value of total assets at beginning of year2015-06-30$7,453,736
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$372,981
Total interest from all sources2015-06-30$249
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$118,352
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-06-30$118,352
Administrative expenses professional fees incurred2015-06-30$120,209
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$1,100,000
If this is an individual account plan, was there a blackout period2015-06-30No
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$384,545
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-06-30$10,500
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-06-30$25,500
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-06-30$9,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-06-30$21,000
Administrative expenses (other) incurred2015-06-30$25,972
Liabilities. Value of operating payables at end of year2015-06-30$26,461
Liabilities. Value of operating payables at beginning of year2015-06-30$22,002
Total non interest bearing cash at end of year2015-06-30$471,023
Total non interest bearing cash at beginning of year2015-06-30$425,725
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$119,523
Value of net assets at end of year (total assets less liabilities)2015-06-30$7,466,957
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$7,347,434
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Investment advisory and management fees2015-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$5,280,082
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$5,225,955
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-06-30$1,277,713
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-06-30$1,253,556
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-06-30$1,253,556
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-06-30$249
Expenses. Payments to insurance carriers foe the provision of benefits2015-06-30$4,676,128
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-06-30$-64,224
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30Yes
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$4,900,573
Employer contributions (assets) at end of year2015-06-30$532,000
Employer contributions (assets) at beginning of year2015-06-30$523,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$170,863
Contract administrator fees2015-06-30$220,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-06-30No
Liabilities. Value of benefit claims payable at end of year2015-06-30$68,900
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$63,300
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30LINDQUIST LLP
Accountancy firm EIN2015-06-30522385296
2014 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$106,302
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$114,069
Total income from all sources (including contributions)2014-06-30$5,231,542
Total of all expenses incurred2014-06-30$5,190,163
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$4,793,861
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$5,128,248
Value of total assets at end of year2014-06-30$7,453,736
Value of total assets at beginning of year2014-06-30$7,420,124
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$396,302
Total interest from all sources2014-06-30$274
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$78,424
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2014-06-30$78,424
Administrative expenses professional fees incurred2014-06-30$150,522
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$1,100,000
If this is an individual account plan, was there a blackout period2014-06-30No
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$404,689
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-06-30$25,500
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-06-30$27,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-06-30$21,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-06-30$25,000
Other income not declared elsewhere2014-06-30$331
Administrative expenses (other) incurred2014-06-30$20,780
Liabilities. Value of operating payables at end of year2014-06-30$22,002
Liabilities. Value of operating payables at beginning of year2014-06-30$26,069
Total non interest bearing cash at end of year2014-06-30$425,725
Total non interest bearing cash at beginning of year2014-06-30$458,395
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$41,379
Value of net assets at end of year (total assets less liabilities)2014-06-30$7,347,434
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$7,306,055
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Investment advisory and management fees2014-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$5,225,955
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$5,123,264
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-06-30$1,253,556
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-06-30$1,310,465
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-06-30$1,310,465
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-06-30$274
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$4,635,930
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$24,265
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$4,723,559
Employer contributions (assets) at end of year2014-06-30$523,000
Employer contributions (assets) at beginning of year2014-06-30$501,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$157,931
Contract administrator fees2014-06-30$219,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-06-30No
Liabilities. Value of benefit claims payable at end of year2014-06-30$63,300
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$63,000
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30LINDQUIST LLP
Accountancy firm EIN2014-06-30522385296
2013 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$114,069
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$100,930
Total income from all sources (including contributions)2013-06-30$5,367,828
Total of all expenses incurred2013-06-30$5,067,923
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$4,648,422
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$5,375,802
Value of total assets at end of year2013-06-30$7,420,124
Value of total assets at beginning of year2013-06-30$7,107,080
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$419,501
Total interest from all sources2013-06-30$269
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$99,870
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2013-06-30$99,870
Administrative expenses professional fees incurred2013-06-30$170,125
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$1,000,000
If this is an individual account plan, was there a blackout period2013-06-30No
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$429,600
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-06-30$27,000
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-06-30$34,202
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-06-30$25,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-06-30$12,000
Other income not declared elsewhere2013-06-30$1,423
Administrative expenses (other) incurred2013-06-30$25,876
Liabilities. Value of operating payables at end of year2013-06-30$26,069
Liabilities. Value of operating payables at beginning of year2013-06-30$20,930
Total non interest bearing cash at end of year2013-06-30$458,395
Total non interest bearing cash at beginning of year2013-06-30$528,102
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$299,905
Value of net assets at end of year (total assets less liabilities)2013-06-30$7,306,055
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$7,006,150
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Investment advisory and management fees2013-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$5,123,264
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$5,132,930
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-06-30$1,310,465
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-06-30$849,846
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-06-30$849,846
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-06-30$269
Expenses. Payments to insurance carriers foe the provision of benefits2013-06-30$4,545,293
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-06-30$-109,536
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30Yes
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$4,946,202
Employer contributions (assets) at end of year2013-06-30$501,000
Employer contributions (assets) at beginning of year2013-06-30$562,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$103,129
Contract administrator fees2013-06-30$217,500
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-06-30No
Liabilities. Value of benefit claims payable at end of year2013-06-30$63,000
Liabilities. Value of benefit claims payable at beginning of year2013-06-30$68,000
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30No
Opinion of an independent qualified public accountant for this plan2013-06-30Unqualified
Accountancy firm name2013-06-30LINDQUIST LLP
Accountancy firm EIN2013-06-30522385296
2012 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$100,930
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$144,445
Total income from all sources (including contributions)2012-06-30$4,947,215
Total of all expenses incurred2012-06-30$4,602,041
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$4,198,692
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$4,764,639
Value of total assets at end of year2012-06-30$7,107,080
Value of total assets at beginning of year2012-06-30$6,805,421
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$403,349
Total interest from all sources2012-06-30$437
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$115,142
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2012-06-30$115,142
Administrative expenses professional fees incurred2012-06-30$157,946
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$1,100,000
If this is an individual account plan, was there a blackout period2012-06-30No
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$418,697
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-06-30$34,202
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-06-30$23,184
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-06-30$12,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-06-30$22,000
Other income not declared elsewhere2012-06-30$15,156
Administrative expenses (other) incurred2012-06-30$24,310
Liabilities. Value of operating payables at end of year2012-06-30$20,930
Liabilities. Value of operating payables at beginning of year2012-06-30$26,545
Total non interest bearing cash at end of year2012-06-30$528,102
Total non interest bearing cash at beginning of year2012-06-30$350,687
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$345,174
Value of net assets at end of year (total assets less liabilities)2012-06-30$7,006,150
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$6,660,976
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Investment advisory and management fees2012-06-30$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-06-30$5,132,930
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$4,965,947
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-06-30$849,846
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-06-30$1,151,603
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-06-30$1,151,603
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-06-30$437
Expenses. Payments to insurance carriers foe the provision of benefits2012-06-30$4,095,904
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-06-30$51,841
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30Yes
Was there a failure to transmit to the plan any participant contributions2012-06-30No
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Contributions received in cash from employer2012-06-30$4,345,942
Employer contributions (assets) at end of year2012-06-30$562,000
Employer contributions (assets) at beginning of year2012-06-30$314,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$102,788
Contract administrator fees2012-06-30$215,093
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-06-30No
Liabilities. Value of benefit claims payable at end of year2012-06-30$68,000
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$95,900
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30No
Opinion of an independent qualified public accountant for this plan2012-06-30Unqualified
Accountancy firm name2012-06-30LINDQUIST LLP
Accountancy firm EIN2012-06-30522385296
2011 : U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$144,445
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$172,189
Total income from all sources (including contributions)2011-06-30$4,118,174
Total of all expenses incurred2011-06-30$4,588,031
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$4,181,950
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$3,800,490
Value of total assets at end of year2011-06-30$6,805,421
Value of total assets at beginning of year2011-06-30$7,303,022
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$406,081
Total interest from all sources2011-06-30$1,201
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$102,822
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2011-06-30$102,822
Administrative expenses professional fees incurred2011-06-30$143,021
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$1,100,000
If this is an individual account plan, was there a blackout period2011-06-30No
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$386,725
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-06-30$23,184
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-06-30$104,880
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-06-30$22,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-06-30$7,000
Other income not declared elsewhere2011-06-30$193,211
Administrative expenses (other) incurred2011-06-30$17,653
Liabilities. Value of operating payables at end of year2011-06-30$26,545
Liabilities. Value of operating payables at beginning of year2011-06-30$43,489
Total non interest bearing cash at end of year2011-06-30$350,687
Total non interest bearing cash at beginning of year2011-06-30$389,392
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$-469,857
Value of net assets at end of year (total assets less liabilities)2011-06-30$6,660,976
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$7,130,833
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Investment advisory and management fees2011-06-30$5,250
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-06-30$4,965,947
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-06-30$4,842,676
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-06-30$1,151,603
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-06-30$1,625,074
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-06-30$1,625,074
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$1,201
Expenses. Payments to insurance carriers foe the provision of benefits2011-06-30$3,792,896
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-06-30$20,450
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30No
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$3,413,765
Employer contributions (assets) at end of year2011-06-30$314,000
Employer contributions (assets) at beginning of year2011-06-30$341,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$389,054
Contract administrator fees2011-06-30$240,157
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-06-30No
Liabilities. Value of benefit claims payable at end of year2011-06-30$95,900
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$121,700
Did the plan have assets held for investment2011-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30LINDQUIST LLP
Accountancy firm EIN2011-06-30522385296

Form 5500 Responses for U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN

2021: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entityMulti-employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-07-01Type of plan entityMulti-employer plan
2020-07-01Plan is a collectively bargained planYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-07-01Type of plan entityMulti-employer plan
2019-07-01Plan is a collectively bargained planYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entityMulti-employer plan
2018-07-01Plan is a collectively bargained planYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entityMulti-employer plan
2017-07-01Plan is a collectively bargained planYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entityMulti-employer plan
2016-07-01Plan is a collectively bargained planYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entityMulti-employer plan
2015-07-01Plan is a collectively bargained planYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-07-01Type of plan entityMulti-employer plan
2014-07-01Plan is a collectively bargained planYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-07-01Type of plan entityMulti-employer plan
2013-07-01Plan is a collectively bargained planYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-07-01Type of plan entityMulti-employer plan
2012-07-01Plan is a collectively bargained planYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-07-01Type of plan entityMulti-employer plan
2011-07-01Plan is a collectively bargained planYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2009: U.A. LOCAL NO. 159 HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-07-01Type of plan entityMulti-employer plan
2009-07-01This submission is the final filingNo
2009-07-01Plan is a collectively bargained planYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340189
Policy instance 2
Insurance contract or identification number3340189
Number of Individuals Covered45
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0051619
Policy instance 1
Insurance contract or identification numberW0051619
Number of Individuals Covered105
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,221,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 3
Insurance contract or identification number01513
Number of Individuals Covered721
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $474,057
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 number31159-0000
Policy instance 4
Insurance contract or identification number31159-0000
Number of Individuals Covered727
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,728,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 5
Insurance contract or identification numberFLX961752
Number of Individuals Covered424
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $29,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 6
Insurance contract or identification numberOK961836
Number of Individuals Covered12
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract numberS5921/79413
Policy instance 7
Insurance contract or identification numberS5921/79413
Number of Individuals Covered74
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $209,336
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 number12145043
Policy instance 8
Insurance contract or identification number12145043
Number of Individuals Covered303
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $41,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered421
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,700
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered744
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $4,142,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered246
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered745
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $517,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract numberS5921/79413
Policy instance 5
Insurance contract or identification numberS5921/79413
Number of Individuals Covered70
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $227,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0051619
Policy instance 7
Insurance contract or identification numberW0051619
Number of Individuals Covered120
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,327,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340189
Policy instance 8
Insurance contract or identification number3340189
Number of Individuals Covered45
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,151
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 number12145043
Policy instance 6
Insurance contract or identification number12145043
Number of Individuals Covered341
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340189
Policy instance 8
Insurance contract or identification number3340189
Number of Individuals Covered45
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0051619
Policy instance 7
Insurance contract or identification numberW0051619
Number of Individuals Covered146
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,507,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered382
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract numberS5921/79413
Policy instance 5
Insurance contract or identification numberS5921/79413
Number of Individuals Covered66
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered830
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $592,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered246
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,886
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered832
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $4,327,741
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 number12145043
Policy instance 6
Insurance contract or identification number12145043
Number of Individuals Covered382
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered287
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,009
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 number12145043
Policy instance 6
Insurance contract or identification number12145043
Number of Individuals Covered415
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340189
Policy instance 8
Insurance contract or identification number3340189
Number of Individuals Covered44
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0051619
Policy instance 7
Insurance contract or identification numberW0051619
Number of Individuals Covered144
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,541,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered842
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $4,093,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered287
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered903
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $632,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract numberS5921/79413
Policy instance 5
Insurance contract or identification numberS5921/79413
Number of Individuals Covered140
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,701
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 number12145043
Policy instance 6
Insurance contract or identification number12145043
Number of Individuals Covered380
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340189
Policy instance 8
Insurance contract or identification number3340189
Number of Individuals Covered40
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract numberS5921/79413
Policy instance 5
Insurance contract or identification numberS5921/79413
Number of Individuals Covered75
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $334,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered266
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0051619
Policy instance 7
Insurance contract or identification numberW0051619
Number of Individuals Covered164
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,622,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered266
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered838
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $533,457
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered711
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $3,090,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered232
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0051619
Policy instance 8
Insurance contract or identification numberW0051619
Number of Individuals Covered185
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,300,984
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 number12145043
Policy instance 7
Insurance contract or identification number12145043
Number of Individuals Covered344
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAREINGTON (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCIX-PPOG
Policy instance 6
Insurance contract or identification numberCIX-PPOG
Number of Individuals Covered40
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,963
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,391
Insurance broker organization code?3
Insurance broker nameMWL
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS5921
Policy instance 5
Insurance contract or identification numberS5921
Number of Individuals Covered75
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $304,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered698
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $474,070
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered653
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $2,665,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered232
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered191
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,233
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered554
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $2,596,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberH12287/H12286
Policy instance 8
Insurance contract or identification numberH12287/H12286
Number of Individuals Covered196
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,332,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered605
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $418,973
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 numberS5921
Policy instance 5
Insurance contract or identification numberS5921
Number of Individuals Covered77
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $298,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAREINGTON (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCIX-PPOG
Policy instance 6
Insurance contract or identification numberCIX-PPOG
Number of Individuals Covered42
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $1,968
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,398
Insurance broker organization code?3
Insurance broker nameMWL
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12145043
Policy instance 7
Insurance contract or identification number12145043
Number of Individuals Covered316
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered191
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberH12287/H12286
Policy instance 8
Insurance contract or identification numberH12287/H12286
Number of Individuals Covered203
Insurance policy start date2014-01-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $641,572
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 number12145043
Policy instance 7
Insurance contract or identification number12145043
Number of Individuals Covered313
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAREINGTON (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCIX-PPOG
Policy instance 6
Insurance contract or identification numberCIX-PPOG
Number of Individuals Covered40
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,813
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,289
Insurance broker organization code?3
Insurance broker nameMWL
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered612
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $425,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered191
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,298
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered550
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH CARE SERVICE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $2,493,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered191
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,945
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 number0743188/21504
Policy instance 5
Insurance contract or identification number0743188/21504
Number of Individuals Covered248
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $923,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberCIX-PPOG
Policy instance 6
Insurance contract or identification numberCIX-PPOG
Number of Individuals Covered39
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,579
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,124
Insurance broker organization code?3
Insurance broker nameMORGAN WHITE, LTD
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0743188/21504
Policy instance 5
Insurance contract or identification number0743188/21504
Number of Individuals Covered91
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,635,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 4
Insurance contract or identification number01513
Number of Individuals Covered660
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $348,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 3
Insurance contract or identification numberOK961836
Number of Individuals Covered186
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,243
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 number31159-0000
Policy instance 2
Insurance contract or identification number31159-0000
Number of Individuals Covered557
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH CARE SERVICE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $1,973,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 1
Insurance contract or identification numberFLX961752
Number of Individuals Covered186
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 2
Insurance contract or identification numberFLX961752
Number of Individuals Covered186
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,089
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 number0743188/21504
Policy instance 8
Insurance contract or identification number0743188/21504
Number of Individuals Covered250
Insurance policy start date2011-11-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,100,375
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: 53031 )
Policy contract number12146783
Policy instance 7
Insurance contract or identification number12146783
Number of Individuals Covered128
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number01513
Policy instance 6
Insurance contract or identification number01513
Number of Individuals Covered559
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $233,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAREINGTON INTERNATIONAL CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCIX-903
Policy instance 5
Insurance contract or identification numberCIX-903
Number of Individuals Covered33
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $1,513
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3331863
Policy instance 1
Insurance contract or identification number3331863
Number of Individuals Covered151
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,633,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 4
Insurance contract or identification numberOK961836
Number of Individuals Covered186
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,032
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 number31159-0000
Policy instance 3
Insurance contract or identification number31159-0000
Number of Individuals Covered504
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH CARE SERVICE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $1,988,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3331863
Policy instance 1
Insurance contract or identification number3331863
Number of Individuals Covered188
Insurance policy start date2009-08-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,055,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAREINGTON INTERNATIONAL CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCIX-903
Policy instance 5
Insurance contract or identification numberCIX-903
Number of Individuals Covered34
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $1,522
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK961836
Policy instance 4
Insurance contract or identification numberOK961836
Number of Individuals Covered194
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,499
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 number31159-0000
Policy instance 3
Insurance contract or identification number31159-0000
Number of Individuals Covered458
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH CARE SERVICE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $1,983,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX961752
Policy instance 2
Insurance contract or identification numberFLX961752
Number of Individuals Covered194
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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