401k Plan data: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES plan

ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 401k Plan overview

Plan Name	ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES
Plan identification number	501

ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

ASSOCIATED PRODUCE DEALERS AND BROKERS OF LOS ANGELES has sponsored the creation of one or more 401k plans.

Company Name: ASSOCIATED PRODUCE DEALERS AND BROKERS OF LOS ANGELES

Employer identification number (EIN): 950509710

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Additional information about ASSOCIATED PRODUCE DEALERS AND BROKERS OF LOS ANGELES

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 1961-08-18

Company Identification Number: C0418969

Legal Registered Office Address: 1601 E. Olympic Blvd. #312

Los Angeles
United States of America (USA)
90021

More information about ASSOCIATED PRODUCE DEALERS AND BROKERS OF LOS ANGELES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 RONALD BATEMAN
501 2016-01-01 RONALD BATEMAN
501 2015-01-01 RONALD BATEMAN
501 2014-01-01 RONALD BATEMAN
501 2013-01-01 RONALD BATEMAN
501 2012-01-01 RONALD BATEMAN
501 2011-01-01 RONALD BATEMAN
501 2010-01-01 RONALD BATEMAN
501 2009-01-01 RONALD BATEMAN

Plan Statistics for ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES

401k plan membership statisitcs for ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES

Measure Date Value
2022: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2022 401k membership
Total participants, beginning-of-year 2022-01-01 920
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 976
Total of all active and inactive participants 2022-01-01 976
Total participants 2022-01-01 976
2021: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,511
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 920
Total of all active and inactive participants 2021-01-01 920
Total participants 2021-01-01 920
2020: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,708
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,511
Total of all active and inactive participants 2020-01-01 1,511
Total participants 2020-01-01 1,511
2019: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,676
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,708
Total of all active and inactive participants 2019-01-01 1,708
Total participants 2019-01-01 1,708
Number of participants with account balances 2019-01-01 0
2018: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,778
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,676
Total of all active and inactive participants 2018-01-01 1,676
Total participants 2018-01-01 1,676
2017: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,663
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,778
Total of all active and inactive participants 2017-01-01 1,778
Total participants 2017-01-01 1,778
2016: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,843
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,663
Total of all active and inactive participants 2016-01-01 1,663
Total participants 2016-01-01 1,663
2015: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,859
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,843
Total of all active and inactive participants 2015-01-01 1,843
Total participants 2015-01-01 0
2014: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,748
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,859
Total of all active and inactive participants 2014-01-01 1,859
Total participants 2014-01-01 0
2013: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,577
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,748
Total of all active and inactive participants 2013-01-01 1,748
Total participants 2013-01-01 0
2012: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,569
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,577
Total of all active and inactive participants 2012-01-01 1,577
Total participants 2012-01-01 0
2011: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,556
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,569
Total of all active and inactive participants 2011-01-01 1,569
Total participants 2011-01-01 1,569
2010: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,642
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,556
Total of all active and inactive participants 2010-01-01 1,556
Total participants 2010-01-01 1,556
2009: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,734
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,642
Total of all active and inactive participants 2009-01-01 1,642
Total participants 2009-01-01 1,642

Measure	Date	Value
2022: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2022 401k membership
Total participants, beginning-of-year	2022-01-01	920
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	976
Total of all active and inactive participants	2022-01-01	976
Total participants	2022-01-01	976
2021: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,511
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	920
Total of all active and inactive participants	2021-01-01	920
Total participants	2021-01-01	920
2020: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,708
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,511
Total of all active and inactive participants	2020-01-01	1,511
Total participants	2020-01-01	1,511
2019: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,676
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,708
Total of all active and inactive participants	2019-01-01	1,708
Total participants	2019-01-01	1,708
Number of participants with account balances	2019-01-01	0
2018: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,778
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,676
Total of all active and inactive participants	2018-01-01	1,676
Total participants	2018-01-01	1,676
2017: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,663
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,778
Total of all active and inactive participants	2017-01-01	1,778
Total participants	2017-01-01	1,778
2016: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,843
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,663
Total of all active and inactive participants	2016-01-01	1,663
Total participants	2016-01-01	1,663
2015: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,859
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,843
Total of all active and inactive participants	2015-01-01	1,843
Total participants	2015-01-01	0
2014: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,748
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,859
Total of all active and inactive participants	2014-01-01	1,859
Total participants	2014-01-01	0
2013: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,577
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,748
Total of all active and inactive participants	2013-01-01	1,748
Total participants	2013-01-01	0
2012: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,569
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,577
Total of all active and inactive participants	2012-01-01	1,577
Total participants	2012-01-01	0
2011: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,556
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,569
Total of all active and inactive participants	2011-01-01	1,569
Total participants	2011-01-01	1,569
2010: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,642
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,556
Total of all active and inactive participants	2010-01-01	1,556
Total participants	2010-01-01	1,556
2009: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,734
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,642
Total of all active and inactive participants	2009-01-01	1,642
Total participants	2009-01-01	1,642

Form 5500 Responses for ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES

2022: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2021 form 5500 responses
2021-01-01	Type of plan entity	Mulitple employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2020 form 5500 responses
2020-01-01	Type of plan entity	Mulitple employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2019 form 5500 responses
2019-01-01	Type of plan entity	Mulitple employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2018 form 5500 responses
2018-01-01	Type of plan entity	Mulitple employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2017 form 5500 responses
2017-01-01	Type of plan entity	Mulitple employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2010 form 5500 responses
2010-01-01	Type of plan entity	Mulitple employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ASSOCIATED PRODUCE DEALERS AND BROKERS INC., EMPLOYEES 2009 form 5500 responses
2009-01-01	Type of plan entity	Mulitple employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	606
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,859
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,859
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

102670

Policy instance

Insurance contract or identification number	102670
Number of Individuals Covered	105
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $36,435
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $770,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,861
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

604803

Policy instance

Insurance contract or identification number	604803
Number of Individuals Covered	69
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $20,768
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $325,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,461
Insurance broker organization code?	3

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0169466HNO

Policy instance

Insurance contract or identification number	0169466HNO
Number of Individuals Covered	1232
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $339,162
Welfare Benefit Premiums Paid to Carrier	USD $7,145,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $339,162
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0169466

Policy instance

Insurance contract or identification number	0169466
Number of Individuals Covered	154
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $52,187
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,126,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,187
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BW6F

Policy instance

Insurance contract or identification number	G000BW6F
Number of Individuals Covered	598
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,734
Total amount of fees paid to insurance company	USD $1,379
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,734
Amount paid for insurance broker fees	1379
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565

Policy instance

Insurance contract or identification number	870565
Number of Individuals Covered	252
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,944
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $138,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,944
Insurance broker organization code?	3

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

252577

Policy instance

Insurance contract or identification number	252577
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $17,224
Welfare Benefit Premiums Paid to Carrier	USD $391,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,856
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	623
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,631
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,631
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

102670

Policy instance

Insurance contract or identification number	102670
Number of Individuals Covered	114
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $39,428
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $683,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,657
Insurance broker organization code?	3

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0169466HNO

Policy instance

Insurance contract or identification number	0169466HNO
Number of Individuals Covered	1120
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $235,179
Welfare Benefit Premiums Paid to Carrier	USD $5,410,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $235,179
Insurance broker organization code?	3

LIBERTY DENTAL PLAN REINSURANCE COMPANY, LTD (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203005

Policy instance

Insurance contract or identification number	203005
Number of Individuals Covered	51
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $544
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $544
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	710
Insurance policy start date	2021-01-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $46,168
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,859,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,788
Insurance broker organization code?	3

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	772
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,770
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,770
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

604803

Policy instance

Insurance contract or identification number	604803
Number of Individuals Covered	67
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $20,071
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $559,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,037
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BW6F

Policy instance

Insurance contract or identification number	G000BW6F
Number of Individuals Covered	632
Insurance policy start date	2021-04-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $4,259
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $28,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,259
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0169466

Policy instance

Insurance contract or identification number	0169466
Number of Individuals Covered	134
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $27,915
Total amount of fees paid to insurance company	USD $31,050
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $751,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	31050
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $27,915

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

604803

Policy instance

Insurance contract or identification number	604803
Number of Individuals Covered	83
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $16,791
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $467,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,080
Insurance broker organization code?	3

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	1885
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $15,293
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $281,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	15293
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

102670

Policy instance

Insurance contract or identification number	102670
Number of Individuals Covered	195
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $56,757
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,576,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,054
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1126
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,124
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $187,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,124
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	744
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $206,383
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,278,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,477
Insurance broker organization code?	3

LIBERTY DENTAL PLAN REINSURANCE COMPANY, LTD (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203005

Policy instance

Insurance contract or identification number	203005
Number of Individuals Covered	43
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $603
Welfare Benefit Premiums Paid to Carrier	USD $11,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $603
Insurance broker organization code?	3

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

252577

Policy instance

Insurance contract or identification number	252577
Number of Individuals Covered	474
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $204,567
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,649,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,553
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0901620

Policy instance

Insurance contract or identification number	0901620
Number of Individuals Covered	29
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $23,329
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $531,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,990
Insurance broker organization code?	3

LIBERTY DENTAL PLAN REINSURANCE COMPANY, LTD (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203005

Policy instance

Insurance contract or identification number	203005
Number of Individuals Covered	32
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $486
Welfare Benefit Premiums Paid to Carrier	USD $10,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $486
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

102670

Policy instance

Insurance contract or identification number	102670
Number of Individuals Covered	268
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $67,070
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,679,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,242
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1259
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,832
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $195,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,832
Insurance broker organization code?	3

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	2270
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,722
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $294,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,722
Insurance broker organization code?	3

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

359722

Policy instance

Insurance contract or identification number	359722
Number of Individuals Covered	515
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $244,074
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,547,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,985
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	879
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $224,696
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,033,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,343
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

604803

Policy instance

Insurance contract or identification number	604803
Number of Individuals Covered	76
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $20,078
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $465,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,047
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1261
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,865
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $195,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,865
Insurance broker organization code?	3
Insurance broker name	RONALD J BATEMAN

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565

Policy instance

Insurance contract or identification number	870565
Number of Individuals Covered	404
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $20,380
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $203,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,380
Insurance broker organization code?	3
Insurance broker name	RONALD J BATEMAN

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	875
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $201,113
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,110,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134,707
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

122121

Policy instance

Insurance contract or identification number	122121
Number of Individuals Covered	79
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,005
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $360,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,803
Insurance broker organization code?	3
Insurance broker name	SOLUTION SOURCE INSURANCE

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	2403
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

359722

Policy instance

Insurance contract or identification number	359722
Number of Individuals Covered	559
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $227,465
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,686,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,866
Insurance broker organization code?	3
Insurance broker name	RICHARD ANTHONY ARIAS III

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

245082

Policy instance

Insurance contract or identification number	245082
Number of Individuals Covered	697
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $265,580
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,639,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $199,185
Insurance broker organization code?	3
Insurance broker name	RICHARD ANTHONY ARIAS III

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1380
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,173
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $205,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,173
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	870
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $202,791
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,120,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $124,951
Insurance broker organization code?	3
Insurance broker name	DAVID WAYNE SENFT

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	2300
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $267,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

122121

Policy instance

Insurance contract or identification number	122121
Number of Individuals Covered	43
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,704
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $193,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,704
Insurance broker organization code?	3
Insurance broker name	TEVIS INSURANCE SOLUTIONS, LLC

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565-000, 001

Policy instance

Insurance contract or identification number	870565-000, 001
Number of Individuals Covered	452
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $19,882
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,882
Insurance broker organization code?	3
Insurance broker name	RONALD BATEMAN

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

102670

Policy instance

Insurance contract or identification number	102670
Number of Individuals Covered	386
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $22,138
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,115,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,069
Insurance broker organization code?	3
Insurance broker name	PAUL STRAIN

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1238
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,792
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $193,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,792
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	2344
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $255,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

245082

Policy instance

Insurance contract or identification number	245082
Number of Individuals Covered	661
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $245,564
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,903,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92,230
Insurance broker organization code?	3
Insurance broker name	RICHARD ANTHONY ARIAS III

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

16806

Policy instance

Insurance contract or identification number	16806
Number of Individuals Covered	133
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,635
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,635
Insurance broker name	DDC BROKER - IRMA ARIAS

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	959
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $213,150
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,539,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $141,613
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

354632

Policy instance

Insurance contract or identification number	354632
Number of Individuals Covered	604
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $188,382
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,610,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,782
Insurance broker organization code?	3
Insurance broker name	PAUL STRAIN

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565-000, 001

Policy instance

Insurance contract or identification number	870565-000, 001
Number of Individuals Covered	452
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $21,799
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $217,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	21799
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	2312
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $223,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	919
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $176,555
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,822,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120,962
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

102670

Policy instance

Insurance contract or identification number	102670
Number of Individuals Covered	230
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,688
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $876,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,344
Insurance broker organization code?	3
Insurance broker name	PAUL K. STRAIN

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

16806

Policy instance

Insurance contract or identification number	16806
Number of Individuals Covered	65
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

245084

Policy instance

Insurance contract or identification number	245084
Number of Individuals Covered	508
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $132,183
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,727,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,862
Insurance broker organization code?	3
Insurance broker name	DAVID SENFT

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1076
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,119
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,119
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1026700003,0001

Policy instance

Insurance contract or identification number	1026700003,0001
Number of Individuals Covered	220
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $25,306
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,057,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,653
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050-R1241

Policy instance

Insurance contract or identification number	L6050-R1241
Number of Individuals Covered	880
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $199,054
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,127,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,250
Insurance broker organization code?	3
Insurance broker name	DAVID SENFT

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	2076
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565-000, 001

Policy instance

Insurance contract or identification number	870565-000, 001
Number of Individuals Covered	637
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $26,436
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $257,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,436
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

02406-0001,0002

Policy instance

Insurance contract or identification number	02406-0001,0002
Number of Individuals Covered	93
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,730
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,730
Insurance broker organization code?	3
Insurance broker name	CMA, INC.

SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

219

Policy instance

Insurance contract or identification number	219
Number of Individuals Covered	138
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,950
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,950
Insurance broker organization code?	3
Insurance broker name	RICHARD ANTHONY ARIAS III

SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

219

Policy instance

Insurance contract or identification number	219
Number of Individuals Covered	106
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,013
Welfare Benefit Premiums Paid to Carrier	USD $43,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,013
Insurance broker organization code?	3
Insurance broker name	PAUL K. STRAIN

GOLDEN WEST HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

NP191-PADP 0201

Policy instance

Insurance contract or identification number	NP191-PADP 0201
Number of Individuals Covered	252
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,389
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1093
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,720
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

219

Policy instance

Insurance contract or identification number	219
Number of Individuals Covered	107
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,342
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1026700003,0001

Policy instance

Insurance contract or identification number	1026700003,0001
Number of Individuals Covered	330
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $22,626
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,115,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050F-17114A

Policy instance

Insurance contract or identification number	L6050F-17114A
Number of Individuals Covered	1891
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $189,324
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,256,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565-000, 001

Policy instance

Insurance contract or identification number	870565-000, 001
Number of Individuals Covered	633
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $27,638
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	1941
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

02406-0001,0002

Policy instance

Insurance contract or identification number	02406-0001,0002
Number of Individuals Covered	99
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,091
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

240656

Policy instance

Insurance contract or identification number	240656
Number of Individuals Covered	391
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $143,043
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,178,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

870565-000, 001

Policy instance

Insurance contract or identification number	870565-000, 001
Number of Individuals Covered	570
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $25,589
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $256,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,589
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

219

Policy instance

Insurance contract or identification number	219
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00203000

Policy instance

Insurance contract or identification number	00203000
Number of Individuals Covered	1008
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,726
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,726
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1026700003,0001

Policy instance

Insurance contract or identification number	1026700003,0001
Number of Individuals Covered	340
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $21,104
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $859,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,552
Insurance broker organization code?	3
Insurance broker name	RONALD J. BATEMAN

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

L6050F-17114A

Policy instance

Insurance contract or identification number	L6050F-17114A
Number of Individuals Covered	868
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $206,975
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,682,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,701
Insurance broker organization code?	3
Insurance broker name	DAVID SENFT

GOLDEN WEST HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

NP191-PADP 0201

Policy instance

Insurance contract or identification number	NP191-PADP 0201
Number of Individuals Covered	269
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,572
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,878
Insurance broker organization code?	3
Insurance broker name	DAVID SENFT

LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

203003 & 203004

Policy instance

Insurance contract or identification number	203003 & 203004
Number of Individuals Covered	1465
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $144,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

02406-0001,0002

Policy instance

Insurance contract or identification number	02406-0001,0002
Number of Individuals Covered	99
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,366
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,366
Insurance broker name	CMA, INC.

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

240656 & 241621

Policy instance

Insurance contract or identification number	240656 & 241621
Number of Individuals Covered	485
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $152,445
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,189,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,005
Insurance broker organization code?	3
Insurance broker name	DAVID W. SENFT

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Company Name:	ASSOCIATED PRODUCE DEALERS AND BROKERS OF LOS ANGELES
Employer identification number (EIN):	950509710
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	1961-08-18
Company Identification Number:	C0418969
Legal Registered Office Address:	1601 E. Olympic Blvd. #312 Los Angeles United States of America (USA) 90021