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R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameR & C TOURS GUAM, INC. WELFARE BENEFIT PLAN
Plan identification number 501

R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

R & C TOURS GUAM, INC. has sponsored the creation of one or more 401k plans.

Company Name:R & C TOURS GUAM, INC.
Employer identification number (EIN):980018819
NAIC Classification:561500

Form 5500 Filing Information

Submission information for form 5500 for 401k plan R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01
5012016-01-01
5012015-01-01TAKAYUKI TANAKA
5012014-01-01SHUICHI KATO
5012013-01-01
5012012-01-01HIDEKI SAKAI HIDEKI SAKAI2013-10-14
5012011-01-01HIDEKI SAKAI HIDEKI SAKAI2012-10-15
5012010-01-01HIDEKI SAKAI HIDEKI SAKAI2011-10-16
5012009-01-01HIDEKI SAKAI HIDEKI SAKAI2010-10-11

Plan Statistics for R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN

Measure Date Value
2017: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-010
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
2016: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0157
Total number of active participants reported on line 7a of the Form 55002016-01-0146
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
2015: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0166
Total number of active participants reported on line 7a of the Form 55002015-01-0157
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
2014: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0166
Total number of active participants reported on line 7a of the Form 55002014-01-0166
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0166
2013: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0168
Total number of active participants reported on line 7a of the Form 55002013-01-0166
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0166
2012: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0163
Total number of active participants reported on line 7a of the Form 55002012-01-0168
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0168
2011: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0161
Total number of active participants reported on line 7a of the Form 55002011-01-0162
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-0163
2010: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0162
Total number of active participants reported on line 7a of the Form 55002010-01-0161
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0161
2009: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0172
Total number of active participants reported on line 7a of the Form 55002009-01-0160
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0162

Financial Data on R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN

Measure Date Value
2015 : R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2015 401k financial data
Total income from all sources2015-12-31$0
Expenses. Total of all expenses incurred2015-12-31$0
Benefits paid (including direct rollovers)2015-12-31$0
Total plan assets at end of year2015-12-31$0
Total plan assets at beginning of year2015-12-31$0
Value of fidelity bond covering the plan2015-12-31$15,000
Net income (gross income less expenses)2015-12-31$0
Net plan assets at end of year (total assets less liabilities)2015-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$0
Total contributions received or receivable from employer(s)2015-12-31$0
2014 : R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2014 401k financial data
Total income from all sources2014-12-31$0
Expenses. Total of all expenses incurred2014-12-31$0
Benefits paid (including direct rollovers)2014-12-31$0
Total plan assets at beginning of year2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$15,000
Net income (gross income less expenses)2014-12-31$0
Net plan assets at end of year (total assets less liabilities)2014-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$0
2013 : R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2013 401k financial data
Total income from all sources2013-12-31$0
Expenses. Total of all expenses incurred2013-12-31$0
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$0
Total plan assets at beginning of year2013-12-31$0
Value of fidelity bond covering the plan2013-12-31$15,000
Total contributions received or receivable from participants2013-12-31$0
Net income (gross income less expenses)2013-12-31$0
Net plan assets at end of year (total assets less liabilities)2013-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$0
2012 : R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2012 401k financial data
Total income from all sources2012-12-31$0
Expenses. Total of all expenses incurred2012-12-31$0
Total plan assets at end of year2012-12-31$0
Total plan assets at beginning of year2012-12-31$0
Value of fidelity bond covering the plan2012-12-31$15,000
Net income (gross income less expenses)2012-12-31$0
Net plan assets at end of year (total assets less liabilities)2012-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$0
2011 : R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2011 401k financial data
Total income from all sources2011-12-31$300
Expenses. Total of all expenses incurred2011-12-31$300
Benefits paid (including direct rollovers)2011-12-31$300
Total plan assets at end of year2011-12-31$0
Total plan assets at beginning of year2011-12-31$0
Value of fidelity bond covering the plan2011-12-31$15,000
Total contributions received or receivable from participants2011-12-31$300
Net income (gross income less expenses)2011-12-31$0
Net plan assets at end of year (total assets less liabilities)2011-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
2010 : R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2010 401k financial data
Total income from all sources2010-12-31$360
Expenses. Total of all expenses incurred2010-12-31$360
Benefits paid (including direct rollovers)2010-12-31$360
Total plan assets at end of year2010-12-31$0
Total plan assets at beginning of year2010-12-31$0
Value of fidelity bond covering the plan2010-12-31$15,000
Total contributions received or receivable from participants2010-12-31$360
Net income (gross income less expenses)2010-12-31$0
Net plan assets at end of year (total assets less liabilities)2010-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$0

Form 5500 Responses for R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN

2017: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: R & C TOURS GUAM, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberCW251
Policy instance 1
Insurance contract or identification numberCW251
Number of Individuals Covered24
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $33,892
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-107
Policy instance 3
Insurance contract or identification number1-270-107
Number of Individuals Covered52
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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 $229,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-112
Policy instance 2
Insurance contract or identification number1-270-112
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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 $3,629
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-107
Policy instance 1
Insurance contract or identification number1-270-107
Number of Individuals Covered65
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $261,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-112
Policy instance 2
Insurance contract or identification number1-270-112
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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 $1,337
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-107
Policy instance 1
Insurance contract or identification number1-270-107
Number of Individuals Covered66
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $245,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-107
Policy instance 1
Insurance contract or identification number1-270-107
Number of Individuals Covered63
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $222,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-111/112
Policy instance 2
Insurance contract or identification number1-270-111/112
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $10,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-107
Policy instance 1
Insurance contract or identification number1-270-107
Number of Individuals Covered62
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $232,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-109
Policy instance 1
Insurance contract or identification number1-270-109
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $2,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ISLAND HOME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 31658 )
Policy contract number1-270-107
Policy instance 2
Insurance contract or identification number1-270-107
Number of Individuals Covered64
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare 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 $244,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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