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| Plan Name | HAWAII DENTAL SERVICE GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HAWAII DENTAL SERVICE |
| Employer identification number (EIN): | 990107971 |
| NAIC Classification: | 524140 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-06-01 | ||||
| 501 | 2017-01-01 | JAN IGA |
| Measure | Date | Value |
|---|---|---|
| 2022: HAWAII DENTAL SERVICE GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-06-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 281 |
| Total of all active and inactive participants | 2022-06-01 | 281 |
| 2017: HAWAII DENTAL SERVICE GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| 2022: HAWAII DENTAL SERVICE GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2022 form 5500 responses | ||
|---|---|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | First time form 5500 has been submitted | Yes |
| 2022-06-01 | Submission has been amended | No |
| 2022-06-01 | This submission is the final filing | No |
| 2022-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-06-01 | Plan is a collectively bargained plan | No |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HAWAII DENTAL SERVICE GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | Yes |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 9052 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 008733 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1679 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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