401k Plan data: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN plan

PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN
Plan identification number	501

PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PACIFIC WHALE FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC WHALE FOUNDATION

Employer identification number (EIN): 990207417

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 STEVE MULLINS 2025-01-13
501 2022-07-01 KRISTIE WRIGGLESWORTH 2024-03-27
501 2021-07-01 KRISTIE WRIGGLESWORTH 2023-01-10
501 2020-07-01 KRISTIE WRIGGLESWORTH 2022-01-13
501 2019-07-01 KRISTIE WRIGGLESWORTH 2021-01-11
501 2018-07-01 KRISTIE WRIGGLESWORTH 2020-01-22
501 2017-07-01 KRISTIE WRIGGLESWORTH
501 2016-07-01 KRISTIE WRIGGLESWORTH
501 2015-07-01 KRISTIE WRIGGLESWORTH
501 2014-07-01 KRISTIE WRIGGLESWORTH
501 2013-07-01 KRISTIE WRIGGLESWORTH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-07-01	STEVE MULLINS	2025-01-13
501	2022-07-01	KRISTIE WRIGGLESWORTH	2024-03-27
501	2021-07-01	KRISTIE WRIGGLESWORTH	2023-01-10
501	2020-07-01	KRISTIE WRIGGLESWORTH	2022-01-13
501	2019-07-01	KRISTIE WRIGGLESWORTH	2021-01-11
501	2018-07-01	KRISTIE WRIGGLESWORTH	2020-01-22
501	2017-07-01	KRISTIE WRIGGLESWORTH
501	2016-07-01	KRISTIE WRIGGLESWORTH
501	2015-07-01	KRISTIE WRIGGLESWORTH
501	2014-07-01	KRISTIE WRIGGLESWORTH
501	2013-07-01	KRISTIE WRIGGLESWORTH

Form 5500 Responses for PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN

2023: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2022: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: PACIFIC WHALE FOUNDATION HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GLTD0BKYB

Policy instance

Insurance contract or identification number	GLTD0BKYB
Number of Individuals Covered	112
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $4,360
Total amount of fees paid to insurance company	USD $1,380
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $36,120
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: 00000 )

Policy contract number

4844

Policy instance

Insurance contract or identification number	4844
Number of Individuals Covered	81
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $23,031
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $624,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

Insurance contract or identification number	2840
Number of Individuals Covered	91
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $1,354
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

4844

Policy instance

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

Policy contract number

GLTD0BKYB

Policy instance

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

Policy contract number

GLTD0BKYB

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

4844

Policy instance

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

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

Policy contract number

GLUG0BYKYB

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

4844

Policy instance

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

4844

Policy instance

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

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

Policy contract number

GLUG0BYKYB

Policy instance

HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 )

Policy contract number

39049

Policy instance

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

4844

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL153118

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153118

Policy instance

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

39049

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

4844

Policy instance

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2840

Policy instance

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Company Name:	PACIFIC WHALE FOUNDATION
Employer identification number (EIN):	990207417
NAIC Classification:	611000