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LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameLOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN
Plan identification number 501

LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

LOCAL 665 I.A.T.S.E. HEALTH & WELFARE PLAN has sponsored the creation of one or more 401k plans.

Company Name:LOCAL 665 I.A.T.S.E. HEALTH & WELFARE PLAN
Employer identification number (EIN):990228405
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-06-01ALLAN OMO2023-03-14 GORDON SVEC2023-03-14
5012020-06-01ALLAN OMO2022-03-14 GORDON SVEC2022-03-14
5012019-06-01ALLAN OMO2021-03-12 NAOAMI CARTER2021-03-12
5012018-06-01
5012017-06-01ALLAN OMO NAOMI CARTER2019-02-25
5012016-06-01ALLAN OMO NAOMI CARTER2018-03-12
5012015-06-01ALLAN OMO NAOMI CARTER2017-03-13
5012014-06-01ALLAN OMO NAOMI CARTER2016-03-11
5012013-06-01ALLAN OMO NAOMI CARTER2015-03-11
5012012-06-01ALLAN OMO NAOMI CARTER2014-03-14
5012011-06-01ALLAN OMO NAOMI CARTER2013-02-21
5012009-06-01ALLAN OMO NAOMI CARTER2011-03-14

Plan Statistics for LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN

Measure Date Value
2021: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01430
Total number of active participants reported on line 7a of the Form 55002021-06-01489
Total of all active and inactive participants2021-06-01489
Total participants2021-06-01489
Number of employers contributing to the scheme2021-06-01129
2020: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01372
Total number of active participants reported on line 7a of the Form 55002020-06-01430
Total of all active and inactive participants2020-06-01430
Total participants2020-06-01430
Number of employers contributing to the scheme2020-06-01129
2019: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01361
Total number of active participants reported on line 7a of the Form 55002019-06-01372
Total of all active and inactive participants2019-06-01372
Total participants2019-06-01372
Number of employers contributing to the scheme2019-06-01134
2018: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01280
Total number of active participants reported on line 7a of the Form 55002018-06-01361
Total of all active and inactive participants2018-06-01361
Number of employers contributing to the scheme2018-06-01193
2017: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01298
Total number of active participants reported on line 7a of the Form 55002017-06-01280
Total of all active and inactive participants2017-06-01280
Number of employers contributing to the scheme2017-06-01315
2016: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01268
Total number of active participants reported on line 7a of the Form 55002016-06-01298
Total of all active and inactive participants2016-06-01298
Number of employers contributing to the scheme2016-06-01198
2015: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01233
Number of retired or separated participants receiving benefits2015-06-01268
Total of all active and inactive participants2015-06-01268
Number of employers contributing to the scheme2015-06-01280
2014: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01291
Total number of active participants reported on line 7a of the Form 55002014-06-01233
Total of all active and inactive participants2014-06-01233
Number of employers contributing to the scheme2014-06-01193
2013: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01300
Total number of active participants reported on line 7a of the Form 55002013-06-01291
Total of all active and inactive participants2013-06-01291
Number of employers contributing to the scheme2013-06-01211
2012: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01279
Total number of active participants reported on line 7a of the Form 55002012-06-01299
Total of all active and inactive participants2012-06-01299
Number of employers contributing to the scheme2012-06-01179
2011: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01336
Total number of active participants reported on line 7a of the Form 55002011-06-01278
Total of all active and inactive participants2011-06-01278
Number of employers contributing to the scheme2011-06-01232
2009: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01204
Total number of active participants reported on line 7a of the Form 55002009-06-01255
Total of all active and inactive participants2009-06-01255
Number of employers contributing to the scheme2009-06-01169

Financial Data on LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN

Measure Date Value
2022 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-05-31$-1,261,516
Total unrealized appreciation/depreciation of assets2022-05-31$-1,261,516
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-05-31$3,956
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-05-31$667
Total income from all sources (including contributions)2022-05-31$7,117,176
Total loss/gain on sale of assets2022-05-31$-5,932
Total of all expenses incurred2022-05-31$5,384,265
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-05-31$5,252,649
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-05-31$7,936,449
Value of total assets at end of year2022-05-31$15,713,628
Value of total assets at beginning of year2022-05-31$13,977,428
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-05-31$131,616
Total interest from all sources2022-05-31$438,543
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-05-31No
Administrative expenses professional fees incurred2022-05-31$55,060
Was this plan covered by a fidelity bond2022-05-31Yes
Value of fidelity bond cover2022-05-31$500,000
If this is an individual account plan, was there a blackout period2022-05-31No
Were there any nonexempt tranactions with any party-in-interest2022-05-31No
Contributions received from participants2022-05-31$7,980
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-05-31$110,588
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-05-31$88,309
Other income not declared elsewhere2022-05-31$9,632
Administrative expenses (other) incurred2022-05-31$18,476
Liabilities. Value of operating payables at end of year2022-05-31$3,956
Liabilities. Value of operating payables at beginning of year2022-05-31$667
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-05-31No
Value of net income/loss2022-05-31$1,732,911
Value of net assets at end of year (total assets less liabilities)2022-05-31$15,709,672
Value of net assets at beginning of year (total assets less liabilities)2022-05-31$13,976,761
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-05-31No
Were any leases to which the plan was party in default or uncollectible2022-05-31No
Investment advisory and management fees2022-05-31$19,165
Income. Interest from corporate debt instruments2022-05-31$438,543
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-05-31$731,028
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-05-31$1,016,591
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-05-31$1,016,591
Expenses. Payments to insurance carriers foe the provision of benefits2022-05-31$5,252,649
Asset value of US Government securities at end of year2022-05-31$851,212
Asset value of US Government securities at beginning of year2022-05-31$1,004,707
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-05-31No
Was there a failure to transmit to the plan any participant contributions2022-05-31No
Has the plan failed to provide any benefit when due under the plan2022-05-31No
Contributions received in cash from employer2022-05-31$7,928,469
Employer contributions (assets) at end of year2022-05-31$431,396
Employer contributions (assets) at beginning of year2022-05-31$611,803
Asset. Corporate debt instrument preferred debt at end of year2022-05-31$9,442,424
Asset. Corporate debt instrument debt (other) at end of year2022-05-31$4,146,980
Asset. Corporate debt instrument debt (other) at beginning of year2022-05-31$11,256,018
Contract administrator fees2022-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-05-31No
Did the plan have assets held for investment2022-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-05-31No
Aggregate proceeds on sale of assets2022-05-31$15,355,496
Aggregate carrying amount (costs) on sale of assets2022-05-31$15,361,428
Opinion of an independent qualified public accountant for this plan2022-05-31Unqualified
Accountancy firm name2022-05-31WACHI & WATANABE CPA, INC
Accountancy firm EIN2022-05-31990291480
2021 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-05-31$-256,861
Total unrealized appreciation/depreciation of assets2021-05-31$-256,861
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-05-31$667
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-05-31$5,582
Total income from all sources (including contributions)2021-05-31$5,003,871
Total loss/gain on sale of assets2021-05-31$183,663
Total of all expenses incurred2021-05-31$4,730,473
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-05-31$4,623,491
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-05-31$4,694,057
Value of total assets at end of year2021-05-31$13,977,428
Value of total assets at beginning of year2021-05-31$13,708,945
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-05-31$106,982
Total interest from all sources2021-05-31$383,012
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-05-31No
Administrative expenses professional fees incurred2021-05-31$40,829
Was this plan covered by a fidelity bond2021-05-31Yes
Value of fidelity bond cover2021-05-31$500,000
If this is an individual account plan, was there a blackout period2021-05-31No
Were there any nonexempt tranactions with any party-in-interest2021-05-31No
Contributions received from participants2021-05-31$53,046
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-05-31$88,309
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-05-31$92,883
Administrative expenses (other) incurred2021-05-31$10,570
Liabilities. Value of operating payables at end of year2021-05-31$667
Liabilities. Value of operating payables at beginning of year2021-05-31$5,582
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-05-31No
Value of net income/loss2021-05-31$273,398
Value of net assets at end of year (total assets less liabilities)2021-05-31$13,976,761
Value of net assets at beginning of year (total assets less liabilities)2021-05-31$13,703,363
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-05-31No
Were any leases to which the plan was party in default or uncollectible2021-05-31No
Investment advisory and management fees2021-05-31$16,668
Income. Interest from corporate debt instruments2021-05-31$349,010
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-05-31$1,016,591
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-05-31$792,375
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-05-31$792,375
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-05-31$34,002
Expenses. Payments to insurance carriers foe the provision of benefits2021-05-31$4,623,491
Asset value of US Government securities at end of year2021-05-31$1,004,707
Asset value of US Government securities at beginning of year2021-05-31$2,040,097
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-05-31Yes
Was there a failure to transmit to the plan any participant contributions2021-05-31No
Has the plan failed to provide any benefit when due under the plan2021-05-31No
Contributions received in cash from employer2021-05-31$4,641,011
Employer contributions (assets) at end of year2021-05-31$611,803
Employer contributions (assets) at beginning of year2021-05-31$22,456
Asset. Corporate debt instrument debt (other) at end of year2021-05-31$11,256,018
Asset. Corporate debt instrument debt (other) at beginning of year2021-05-31$10,761,134
Contract administrator fees2021-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-05-31No
Did the plan have assets held for investment2021-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-05-31No
Aggregate proceeds on sale of assets2021-05-31$16,934,599
Aggregate carrying amount (costs) on sale of assets2021-05-31$16,750,936
Opinion of an independent qualified public accountant for this plan2021-05-31Unqualified
Accountancy firm name2021-05-31WACHI & WATANABE CPA, INC
Accountancy firm EIN2021-05-31990291480
2020 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-05-31$325,041
Total unrealized appreciation/depreciation of assets2020-05-31$325,041
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-05-31$5,582
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-05-31$5,233
Total income from all sources (including contributions)2020-05-31$6,110,039
Total loss/gain on sale of assets2020-05-31$-8,709
Total of all expenses incurred2020-05-31$4,173,555
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-05-31$4,059,050
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-05-31$5,402,617
Value of total assets at end of year2020-05-31$13,708,945
Value of total assets at beginning of year2020-05-31$11,772,112
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-05-31$114,505
Total interest from all sources2020-05-31$391,090
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-05-31No
Administrative expenses professional fees incurred2020-05-31$30,639
Was this plan covered by a fidelity bond2020-05-31Yes
Value of fidelity bond cover2020-05-31$500,000
If this is an individual account plan, was there a blackout period2020-05-31No
Were there any nonexempt tranactions with any party-in-interest2020-05-31No
Contributions received from participants2020-05-31$97,710
Assets. Other investments not covered elsewhere at beginning of year2020-05-31$85,082
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-05-31$92,883
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-05-31$90,702
Administrative expenses (other) incurred2020-05-31$26,488
Liabilities. Value of operating payables at end of year2020-05-31$5,582
Liabilities. Value of operating payables at beginning of year2020-05-31$5,233
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-05-31No
Value of net income/loss2020-05-31$1,936,484
Value of net assets at end of year (total assets less liabilities)2020-05-31$13,703,363
Value of net assets at beginning of year (total assets less liabilities)2020-05-31$11,766,879
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-05-31No
Were any leases to which the plan was party in default or uncollectible2020-05-31No
Investment advisory and management fees2020-05-31$18,463
Interest earned on other investments2020-05-31$376
Income. Interest from corporate debt instruments2020-05-31$346,806
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-05-31$792,375
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-05-31$596,033
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-05-31$596,033
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-05-31$43,908
Expenses. Payments to insurance carriers foe the provision of benefits2020-05-31$4,059,050
Asset value of US Government securities at end of year2020-05-31$2,040,097
Asset value of US Government securities at beginning of year2020-05-31$923,784
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-05-31Yes
Was there a failure to transmit to the plan any participant contributions2020-05-31No
Has the plan failed to provide any benefit when due under the plan2020-05-31No
Contributions received in cash from employer2020-05-31$5,304,907
Employer contributions (assets) at end of year2020-05-31$22,456
Employer contributions (assets) at beginning of year2020-05-31$523,273
Asset. Corporate debt instrument debt (other) at end of year2020-05-31$10,761,134
Asset. Corporate debt instrument debt (other) at beginning of year2020-05-31$9,553,238
Contract administrator fees2020-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-05-31No
Did the plan have assets held for investment2020-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-05-31No
Aggregate proceeds on sale of assets2020-05-31$15,216,552
Aggregate carrying amount (costs) on sale of assets2020-05-31$15,225,261
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-05-31No
Opinion of an independent qualified public accountant for this plan2020-05-31Unqualified
Accountancy firm name2020-05-31WACHI & WATANABE CPA, INC
Accountancy firm EIN2020-05-31990291480
2019 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-05-31$225,668
Total unrealized appreciation/depreciation of assets2019-05-31$225,668
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-05-31$5,233
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-05-31$145,286
Total income from all sources (including contributions)2019-05-31$6,476,922
Total loss/gain on sale of assets2019-05-31$-74,104
Total of all expenses incurred2019-05-31$3,672,980
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-05-31$3,567,497
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-05-31$6,022,471
Value of total assets at end of year2019-05-31$11,772,112
Value of total assets at beginning of year2019-05-31$9,108,223
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-05-31$105,483
Total interest from all sources2019-05-31$302,887
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-05-31No
Administrative expenses professional fees incurred2019-05-31$26,231
Was this plan covered by a fidelity bond2019-05-31Yes
Value of fidelity bond cover2019-05-31$500,000
If this is an individual account plan, was there a blackout period2019-05-31No
Were there any nonexempt tranactions with any party-in-interest2019-05-31No
Contributions received from participants2019-05-31$77,889
Assets. Other investments not covered elsewhere at end of year2019-05-31$85,082
Assets. Other investments not covered elsewhere at beginning of year2019-05-31$159,729
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-05-31$90,702
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-05-31$73,065
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-05-31$141,640
Administrative expenses (other) incurred2019-05-31$24,338
Liabilities. Value of operating payables at end of year2019-05-31$5,233
Liabilities. Value of operating payables at beginning of year2019-05-31$3,646
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-05-31No
Value of net income/loss2019-05-31$2,803,942
Value of net assets at end of year (total assets less liabilities)2019-05-31$11,766,879
Value of net assets at beginning of year (total assets less liabilities)2019-05-31$8,962,937
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-05-31No
Were any leases to which the plan was party in default or uncollectible2019-05-31No
Investment advisory and management fees2019-05-31$15,999
Interest earned on other investments2019-05-31$3,074
Income. Interest from corporate debt instruments2019-05-31$278,163
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-05-31$596,033
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-05-31$812,592
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-05-31$812,592
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-05-31$21,650
Expenses. Payments to insurance carriers foe the provision of benefits2019-05-31$3,567,497
Asset value of US Government securities at end of year2019-05-31$923,784
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-05-31Yes
Was there a failure to transmit to the plan any participant contributions2019-05-31No
Has the plan failed to provide any benefit when due under the plan2019-05-31No
Contributions received in cash from employer2019-05-31$5,944,582
Employer contributions (assets) at end of year2019-05-31$523,273
Employer contributions (assets) at beginning of year2019-05-31$652,637
Asset. Corporate debt instrument debt (other) at end of year2019-05-31$9,553,238
Asset. Corporate debt instrument debt (other) at beginning of year2019-05-31$7,410,200
Contract administrator fees2019-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-05-31No
Did the plan have assets held for investment2019-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-05-31No
Aggregate proceeds on sale of assets2019-05-31$10,424,692
Aggregate carrying amount (costs) on sale of assets2019-05-31$10,498,796
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-05-31No
Opinion of an independent qualified public accountant for this plan2019-05-31Unqualified
Accountancy firm name2019-05-31LEMKE, CHINEN & TANAKA, C.P.A., INC
Accountancy firm EIN2019-05-31990155373
2018 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-05-31$-118,008
Total unrealized appreciation/depreciation of assets2018-05-31$-118,008
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-05-31$145,286
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-05-31$2,704
Total income from all sources (including contributions)2018-05-31$4,642,605
Total loss/gain on sale of assets2018-05-31$-111,131
Total of all expenses incurred2018-05-31$3,433,629
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-05-31$3,330,238
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-05-31$4,625,818
Value of total assets at end of year2018-05-31$9,108,223
Value of total assets at beginning of year2018-05-31$7,756,665
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-05-31$103,391
Total interest from all sources2018-05-31$245,926
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-05-31No
Administrative expenses professional fees incurred2018-05-31$38,095
Was this plan covered by a fidelity bond2018-05-31Yes
Value of fidelity bond cover2018-05-31$500,000
If this is an individual account plan, was there a blackout period2018-05-31No
Were there any nonexempt tranactions with any party-in-interest2018-05-31No
Contributions received from participants2018-05-31$101,795
Assets. Other investments not covered elsewhere at end of year2018-05-31$159,729
Assets. Other investments not covered elsewhere at beginning of year2018-05-31$252,597
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-05-31$73,065
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-05-31$68,173
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-05-31$141,640
Administrative expenses (other) incurred2018-05-31$11,895
Liabilities. Value of operating payables at end of year2018-05-31$3,646
Liabilities. Value of operating payables at beginning of year2018-05-31$2,704
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-05-31No
Value of net income/loss2018-05-31$1,208,976
Value of net assets at end of year (total assets less liabilities)2018-05-31$8,962,937
Value of net assets at beginning of year (total assets less liabilities)2018-05-31$7,753,961
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-05-31No
Were any leases to which the plan was party in default or uncollectible2018-05-31No
Investment advisory and management fees2018-05-31$14,486
Interest earned on other investments2018-05-31$5,035
Income. Interest from corporate debt instruments2018-05-31$237,214
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-05-31$812,592
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-05-31$674,162
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-05-31$674,162
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-05-31$3,677
Expenses. Payments to insurance carriers foe the provision of benefits2018-05-31$3,330,238
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-05-31Yes
Was there a failure to transmit to the plan any participant contributions2018-05-31No
Has the plan failed to provide any benefit when due under the plan2018-05-31No
Contributions received in cash from employer2018-05-31$4,524,023
Employer contributions (assets) at end of year2018-05-31$652,637
Employer contributions (assets) at beginning of year2018-05-31$585,064
Asset. Corporate debt instrument debt (other) at end of year2018-05-31$7,410,200
Asset. Corporate debt instrument debt (other) at beginning of year2018-05-31$6,176,669
Contract administrator fees2018-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-05-31No
Did the plan have assets held for investment2018-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-05-31No
Aggregate proceeds on sale of assets2018-05-31$12,652,886
Aggregate carrying amount (costs) on sale of assets2018-05-31$12,764,017
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-05-31No
Opinion of an independent qualified public accountant for this plan2018-05-31Unqualified
Accountancy firm name2018-05-31LEMKE, CHINEN & TANAKA, C.P.A., INC
Accountancy firm EIN2018-05-31990155373
2017 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-05-31$-47,763
Total unrealized appreciation/depreciation of assets2017-05-31$-47,763
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-05-31$2,704
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-05-31$9,214
Total income from all sources (including contributions)2017-05-31$4,495,949
Total loss/gain on sale of assets2017-05-31$-43,017
Total of all expenses incurred2017-05-31$2,966,613
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-05-31$2,876,600
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-05-31$4,391,931
Value of total assets at end of year2017-05-31$7,756,665
Value of total assets at beginning of year2017-05-31$6,233,839
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-05-31$90,013
Total interest from all sources2017-05-31$194,798
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-05-31No
Administrative expenses professional fees incurred2017-05-31$24,829
Was this plan covered by a fidelity bond2017-05-31Yes
Value of fidelity bond cover2017-05-31$500,000
If this is an individual account plan, was there a blackout period2017-05-31No
Were there any nonexempt tranactions with any party-in-interest2017-05-31No
Contributions received from participants2017-05-31$99,572
Assets. Other investments not covered elsewhere at end of year2017-05-31$252,597
Assets. Other investments not covered elsewhere at beginning of year2017-05-31$449,405
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-05-31$68,173
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-05-31$51,845
Administrative expenses (other) incurred2017-05-31$12,796
Liabilities. Value of operating payables at end of year2017-05-31$2,704
Liabilities. Value of operating payables at beginning of year2017-05-31$9,214
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-05-31No
Value of net income/loss2017-05-31$1,529,336
Value of net assets at end of year (total assets less liabilities)2017-05-31$7,753,961
Value of net assets at beginning of year (total assets less liabilities)2017-05-31$6,224,625
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-05-31No
Were any leases to which the plan was party in default or uncollectible2017-05-31No
Investment advisory and management fees2017-05-31$13,473
Interest earned on other investments2017-05-31$10,040
Income. Interest from corporate debt instruments2017-05-31$181,356
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-05-31$674,162
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-05-31$694,233
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-05-31$694,233
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-05-31$3,402
Expenses. Payments to insurance carriers foe the provision of benefits2017-05-31$2,876,600
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-05-31Yes
Was there a failure to transmit to the plan any participant contributions2017-05-31No
Has the plan failed to provide any benefit when due under the plan2017-05-31No
Contributions received in cash from employer2017-05-31$4,292,359
Employer contributions (assets) at end of year2017-05-31$585,064
Employer contributions (assets) at beginning of year2017-05-31$225,149
Asset. Corporate debt instrument debt (other) at end of year2017-05-31$6,176,669
Asset. Corporate debt instrument debt (other) at beginning of year2017-05-31$4,813,207
Contract administrator fees2017-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-05-31No
Did the plan have assets held for investment2017-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-05-31No
Aggregate proceeds on sale of assets2017-05-31$7,221,095
Aggregate carrying amount (costs) on sale of assets2017-05-31$7,264,112
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-05-31No
Opinion of an independent qualified public accountant for this plan2017-05-31Unqualified
Accountancy firm name2017-05-31LEMKE, CHINEN & TANAKA, C.P.A., INC
Accountancy firm EIN2017-05-31990155373
2016 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-05-31$-11,513
Total unrealized appreciation/depreciation of assets2016-05-31$-11,513
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$9,214
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$40,450
Total income from all sources (including contributions)2016-05-31$3,732,373
Total loss/gain on sale of assets2016-05-31$-34,279
Total of all expenses incurred2016-05-31$2,590,083
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-05-31$2,499,358
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-05-31$3,620,082
Value of total assets at end of year2016-05-31$6,233,839
Value of total assets at beginning of year2016-05-31$5,122,785
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-05-31$90,725
Total interest from all sources2016-05-31$158,083
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-05-31No
Administrative expenses professional fees incurred2016-05-31$30,919
Was this plan covered by a fidelity bond2016-05-31Yes
Value of fidelity bond cover2016-05-31$500,000
If this is an individual account plan, was there a blackout period2016-05-31No
Were there any nonexempt tranactions with any party-in-interest2016-05-31No
Contributions received from participants2016-05-31$120,683
Assets. Other investments not covered elsewhere at end of year2016-05-31$449,405
Assets. Other investments not covered elsewhere at beginning of year2016-05-31$350,219
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-05-31$51,845
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-05-31$44,450
Administrative expenses (other) incurred2016-05-31$8,408
Liabilities. Value of operating payables at end of year2016-05-31$9,214
Liabilities. Value of operating payables at beginning of year2016-05-31$40,450
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
Value of net income/loss2016-05-31$1,142,290
Value of net assets at end of year (total assets less liabilities)2016-05-31$6,224,625
Value of net assets at beginning of year (total assets less liabilities)2016-05-31$5,082,335
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-05-31No
Were any leases to which the plan was party in default or uncollectible2016-05-31No
Investment advisory and management fees2016-05-31$12,483
Interest earned on other investments2016-05-31$12,686
Income. Interest from corporate debt instruments2016-05-31$140,124
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-05-31$694,233
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-05-31$819,213
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-05-31$819,213
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-05-31$5,273
Expenses. Payments to insurance carriers foe the provision of benefits2016-05-31$2,499,358
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-05-31Yes
Was there a failure to transmit to the plan any participant contributions2016-05-31No
Has the plan failed to provide any benefit when due under the plan2016-05-31No
Contributions received in cash from employer2016-05-31$3,499,399
Employer contributions (assets) at end of year2016-05-31$225,149
Employer contributions (assets) at beginning of year2016-05-31$196,611
Asset. Corporate debt instrument debt (other) at end of year2016-05-31$4,813,207
Asset. Corporate debt instrument debt (other) at beginning of year2016-05-31$3,712,292
Contract administrator fees2016-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-05-31No
Did the plan have assets held for investment2016-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-05-31No
Aggregate proceeds on sale of assets2016-05-31$4,826,258
Aggregate carrying amount (costs) on sale of assets2016-05-31$4,860,537
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-05-31No
Opinion of an independent qualified public accountant for this plan2016-05-31Unqualified
Accountancy firm name2016-05-31LEMKE, CHINEN & TANAKA, C.P.A., INC
Accountancy firm EIN2016-05-31990155373
2015 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-05-31$-22,220
Total unrealized appreciation/depreciation of assets2015-05-31$-22,220
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$40,450
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$8,156
Total income from all sources (including contributions)2015-05-31$2,747,188
Total loss/gain on sale of assets2015-05-31$-29,927
Total of all expenses incurred2015-05-31$2,467,182
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-05-31$2,348,505
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-05-31$2,663,218
Value of total assets at end of year2015-05-31$5,122,785
Value of total assets at beginning of year2015-05-31$4,810,485
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-05-31$118,677
Total interest from all sources2015-05-31$136,117
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-05-31No
Administrative expenses professional fees incurred2015-05-31$26,313
Was this plan covered by a fidelity bond2015-05-31Yes
Value of fidelity bond cover2015-05-31$500,000
If this is an individual account plan, was there a blackout period2015-05-31No
Were there any nonexempt tranactions with any party-in-interest2015-05-31No
Contributions received from participants2015-05-31$173,145
Assets. Other investments not covered elsewhere at end of year2015-05-31$350,219
Assets. Other investments not covered elsewhere at beginning of year2015-05-31$182,761
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-05-31$44,450
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-05-31$33,448
Administrative expenses (other) incurred2015-05-31$41,738
Liabilities. Value of operating payables at end of year2015-05-31$40,450
Liabilities. Value of operating payables at beginning of year2015-05-31$8,156
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Value of net income/loss2015-05-31$280,006
Value of net assets at end of year (total assets less liabilities)2015-05-31$5,082,335
Value of net assets at beginning of year (total assets less liabilities)2015-05-31$4,802,329
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-05-31No
Were any leases to which the plan was party in default or uncollectible2015-05-31No
Investment advisory and management fees2015-05-31$11,711
Interest earned on other investments2015-05-31$8,152
Income. Interest from corporate debt instruments2015-05-31$122,389
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-05-31$819,213
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-05-31$952,393
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-05-31$952,393
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-05-31$5,576
Expenses. Payments to insurance carriers foe the provision of benefits2015-05-31$2,348,505
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-05-31Yes
Was there a failure to transmit to the plan any participant contributions2015-05-31No
Has the plan failed to provide any benefit when due under the plan2015-05-31No
Contributions received in cash from employer2015-05-31$2,490,073
Employer contributions (assets) at end of year2015-05-31$196,611
Employer contributions (assets) at beginning of year2015-05-31$298,723
Asset. Corporate debt instrument debt (other) at end of year2015-05-31$3,712,292
Asset. Corporate debt instrument debt (other) at beginning of year2015-05-31$3,343,160
Contract administrator fees2015-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-05-31No
Did the plan have assets held for investment2015-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-05-31No
Aggregate proceeds on sale of assets2015-05-31$6,221,922
Aggregate carrying amount (costs) on sale of assets2015-05-31$6,251,849
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-05-31No
Opinion of an independent qualified public accountant for this plan2015-05-31Unqualified
Accountancy firm name2015-05-31LEMKE, CHINEN & TANAKA, C.P.A., INC
Accountancy firm EIN2015-05-31990155373
2014 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-05-31$2,686
Total unrealized appreciation/depreciation of assets2014-05-31$2,686
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$8,156
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$5,440
Total income from all sources (including contributions)2014-05-31$3,248,346
Total loss/gain on sale of assets2014-05-31$-27,987
Total of all expenses incurred2014-05-31$2,469,775
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-05-31$2,376,879
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-05-31$3,178,671
Value of total assets at end of year2014-05-31$4,810,485
Value of total assets at beginning of year2014-05-31$4,029,198
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-05-31$92,896
Total interest from all sources2014-05-31$94,976
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-05-31No
Administrative expenses professional fees incurred2014-05-31$28,210
Was this plan covered by a fidelity bond2014-05-31Yes
Value of fidelity bond cover2014-05-31$500,000
If this is an individual account plan, was there a blackout period2014-05-31No
Were there any nonexempt tranactions with any party-in-interest2014-05-31No
Contributions received from participants2014-05-31$148,772
Assets. Other investments not covered elsewhere at end of year2014-05-31$182,761
Assets. Other investments not covered elsewhere at beginning of year2014-05-31$105,609
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-05-31$33,448
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-05-31$19,938
Administrative expenses (other) incurred2014-05-31$14,401
Liabilities. Value of operating payables at end of year2014-05-31$8,156
Liabilities. Value of operating payables at beginning of year2014-05-31$5,440
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Value of net income/loss2014-05-31$778,571
Value of net assets at end of year (total assets less liabilities)2014-05-31$4,802,329
Value of net assets at beginning of year (total assets less liabilities)2014-05-31$4,023,758
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-05-31No
Were any leases to which the plan was party in default or uncollectible2014-05-31No
Investment advisory and management fees2014-05-31$11,370
Interest earned on other investments2014-05-31$4,642
Income. Interest from US Government securities2014-05-31$11,225
Income. Interest from corporate debt instruments2014-05-31$69,236
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-05-31$952,393
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-05-31$1,339,444
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-05-31$1,339,444
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-05-31$9,873
Expenses. Payments to insurance carriers foe the provision of benefits2014-05-31$2,376,879
Asset value of US Government securities at beginning of year2014-05-31$1,134,383
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-05-31Yes
Was there a failure to transmit to the plan any participant contributions2014-05-31No
Has the plan failed to provide any benefit when due under the plan2014-05-31No
Contributions received in cash from employer2014-05-31$3,029,899
Employer contributions (assets) at end of year2014-05-31$298,723
Employer contributions (assets) at beginning of year2014-05-31$193,176
Asset. Corporate debt instrument debt (other) at end of year2014-05-31$3,343,160
Asset. Corporate debt instrument debt (other) at beginning of year2014-05-31$1,236,648
Contract administrator fees2014-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-05-31No
Did the plan have assets held for investment2014-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-05-31No
Aggregate proceeds on sale of assets2014-05-31$7,356,649
Aggregate carrying amount (costs) on sale of assets2014-05-31$7,384,636
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-05-31No
Opinion of an independent qualified public accountant for this plan2014-05-31Unqualified
Accountancy firm name2014-05-31LEMKE, CHINEN & TANAKA, C.P.A., INC
Accountancy firm EIN2014-05-31990155373
2013 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-05-31$-20,289
Total unrealized appreciation/depreciation of assets2013-05-31$-20,289
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$5,440
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$3,502
Total income from all sources (including contributions)2013-05-31$3,070,751
Total loss/gain on sale of assets2013-05-31$-1,925
Total of all expenses incurred2013-05-31$2,435,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-05-31$2,349,979
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-05-31$3,041,247
Value of total assets at end of year2013-05-31$4,029,198
Value of total assets at beginning of year2013-05-31$3,392,144
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-05-31$85,656
Total interest from all sources2013-05-31$51,718
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-05-31No
Administrative expenses professional fees incurred2013-05-31$25,435
Was this plan covered by a fidelity bond2013-05-31Yes
Value of fidelity bond cover2013-05-31$500,000
If this is an individual account plan, was there a blackout period2013-05-31No
Were there any nonexempt tranactions with any party-in-interest2013-05-31No
Contributions received from participants2013-05-31$201,617
Assets. Other investments not covered elsewhere at end of year2013-05-31$105,609
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-05-31$19,938
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-05-31$7,462
Administrative expenses (other) incurred2013-05-31$11,074
Liabilities. Value of operating payables at end of year2013-05-31$5,440
Liabilities. Value of operating payables at beginning of year2013-05-31$3,502
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Value of net income/loss2013-05-31$635,116
Value of net assets at end of year (total assets less liabilities)2013-05-31$4,023,758
Value of net assets at beginning of year (total assets less liabilities)2013-05-31$3,388,642
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-05-31No
Were any leases to which the plan was party in default or uncollectible2013-05-31No
Investment advisory and management fees2013-05-31$10,232
Interest earned on other investments2013-05-31$259
Income. Interest from US Government securities2013-05-31$19,950
Income. Interest from corporate debt instruments2013-05-31$23,538
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-05-31$1,339,444
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-05-31$1,407,601
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-05-31$1,407,601
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-05-31$7,971
Expenses. Payments to insurance carriers foe the provision of benefits2013-05-31$2,349,979
Asset value of US Government securities at end of year2013-05-31$1,134,383
Asset value of US Government securities at beginning of year2013-05-31$1,923,939
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-05-31Yes
Was there a failure to transmit to the plan any participant contributions2013-05-31No
Has the plan failed to provide any benefit when due under the plan2013-05-31No
Contributions received in cash from employer2013-05-31$2,839,630
Employer contributions (assets) at end of year2013-05-31$193,176
Employer contributions (assets) at beginning of year2013-05-31$53,142
Asset. Corporate debt instrument debt (other) at end of year2013-05-31$1,236,648
Contract administrator fees2013-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-05-31No
Did the plan have assets held for investment2013-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-05-31No
Aggregate proceeds on sale of assets2013-05-31$5,883,877
Aggregate carrying amount (costs) on sale of assets2013-05-31$5,885,802
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-05-31No
Opinion of an independent qualified public accountant for this plan2013-05-31Unqualified
Accountancy firm name2013-05-31LEMKE, CHINEN & TANAKA, CPA, INC.
Accountancy firm EIN2013-05-31990155373
2012 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-05-31$-3,564
Total unrealized appreciation/depreciation of assets2012-05-31$-3,564
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$3,502
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$16,039
Total income from all sources (including contributions)2012-05-31$2,386,777
Total loss/gain on sale of assets2012-05-31$-1,726
Total of all expenses incurred2012-05-31$2,182,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-05-31$2,098,734
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-05-31$2,356,488
Value of total assets at end of year2012-05-31$3,392,144
Value of total assets at beginning of year2012-05-31$3,199,911
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-05-31$83,273
Total interest from all sources2012-05-31$31,209
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-05-31No
Administrative expenses professional fees incurred2012-05-31$24,790
Was this plan covered by a fidelity bond2012-05-31Yes
Value of fidelity bond cover2012-05-31$350,000
If this is an individual account plan, was there a blackout period2012-05-31No
Were there any nonexempt tranactions with any party-in-interest2012-05-31No
Contributions received from participants2012-05-31$216,157
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-05-31$7,462
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-05-31$95,483
Other income not declared elsewhere2012-05-31$4,370
Administrative expenses (other) incurred2012-05-31$11,509
Liabilities. Value of operating payables at end of year2012-05-31$3,502
Liabilities. Value of operating payables at beginning of year2012-05-31$16,039
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Value of net income/loss2012-05-31$204,770
Value of net assets at end of year (total assets less liabilities)2012-05-31$3,388,642
Value of net assets at beginning of year (total assets less liabilities)2012-05-31$3,183,872
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-05-31No
Were any leases to which the plan was party in default or uncollectible2012-05-31No
Investment advisory and management fees2012-05-31$8,059
Income. Interest from US Government securities2012-05-31$30,089
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-05-31$1,407,601
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-05-31$386,893
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-05-31$386,893
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-05-31$1,120
Expenses. Payments to insurance carriers foe the provision of benefits2012-05-31$2,098,734
Asset value of US Government securities at end of year2012-05-31$1,923,939
Asset value of US Government securities at beginning of year2012-05-31$2,702,131
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-05-31Yes
Was there a failure to transmit to the plan any participant contributions2012-05-31No
Has the plan failed to provide any benefit when due under the plan2012-05-31No
Contributions received in cash from employer2012-05-31$2,140,331
Employer contributions (assets) at end of year2012-05-31$53,142
Employer contributions (assets) at beginning of year2012-05-31$15,404
Contract administrator fees2012-05-31$38,915
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-05-31No
Did the plan have assets held for investment2012-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-05-31No
Aggregate proceeds on sale of assets2012-05-31$2,667,583
Aggregate carrying amount (costs) on sale of assets2012-05-31$2,669,309
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-05-31No
Opinion of an independent qualified public accountant for this plan2012-05-31Unqualified
Accountancy firm name2012-05-31LEMKE, CHINEN & TANAKA CPA INC
Accountancy firm EIN2012-05-31990155373
2011 : LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-05-31$4,338
Total unrealized appreciation/depreciation of assets2011-05-31$4,338
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$16,039
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$4,687
Total income from all sources (including contributions)2011-05-31$2,902,472
Total loss/gain on sale of assets2011-05-31$-5,469
Total of all expenses incurred2011-05-31$2,115,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-05-31$2,028,045
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-05-31$2,833,773
Value of total assets at end of year2011-05-31$3,199,911
Value of total assets at beginning of year2011-05-31$2,401,196
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-05-31$87,064
Total interest from all sources2011-05-31$38,574
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-05-31No
Administrative expenses professional fees incurred2011-05-31$36,096
Was this plan covered by a fidelity bond2011-05-31Yes
Value of fidelity bond cover2011-05-31$350,000
If this is an individual account plan, was there a blackout period2011-05-31No
Were there any nonexempt tranactions with any party-in-interest2011-05-31No
Contributions received from participants2011-05-31$88,299
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-05-31$95,483
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-05-31$62,326
Other income not declared elsewhere2011-05-31$31,256
Administrative expenses (other) incurred2011-05-31$8,718
Liabilities. Value of operating payables at end of year2011-05-31$16,039
Liabilities. Value of operating payables at beginning of year2011-05-31$4,687
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Value of net income/loss2011-05-31$787,363
Value of net assets at end of year (total assets less liabilities)2011-05-31$3,183,872
Value of net assets at beginning of year (total assets less liabilities)2011-05-31$2,396,509
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-05-31No
Were any leases to which the plan was party in default or uncollectible2011-05-31No
Investment advisory and management fees2011-05-31$5,102
Income. Interest from US Government securities2011-05-31$37,051
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-05-31$386,893
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-05-31$900,040
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-05-31$900,040
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-05-31$1,523
Expenses. Payments to insurance carriers foe the provision of benefits2011-05-31$2,028,045
Asset value of US Government securities at end of year2011-05-31$2,702,131
Asset value of US Government securities at beginning of year2011-05-31$1,098,153
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-05-31Yes
Was there a failure to transmit to the plan any participant contributions2011-05-31No
Has the plan failed to provide any benefit when due under the plan2011-05-31No
Contributions received in cash from employer2011-05-31$2,745,474
Employer contributions (assets) at end of year2011-05-31$15,404
Employer contributions (assets) at beginning of year2011-05-31$340,677
Contract administrator fees2011-05-31$37,148
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-05-31No
Did the plan have assets held for investment2011-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-05-31No
Aggregate proceeds on sale of assets2011-05-31$3,489,654
Aggregate carrying amount (costs) on sale of assets2011-05-31$3,495,123
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-05-31No
Opinion of an independent qualified public accountant for this plan2011-05-31Unqualified
Accountancy firm name2011-05-31LEMKE, CHINEN & TANAKA CPA INC
Accountancy firm EIN2011-05-31990155373

Form 5500 Responses for LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN

2021: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-06-01Type of plan entityMulti-employer plan
2021-06-01Plan is a collectively bargained planYes
2021-06-01Plan funding arrangement – TrustYes
2021-06-01Plan benefit arrangement – InsuranceYes
2020: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-06-01Type of plan entityMulti-employer plan
2020-06-01Plan is a collectively bargained planYes
2020-06-01Plan funding arrangement – TrustYes
2020-06-01Plan benefit arrangement – InsuranceYes
2019: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-06-01Type of plan entityMulti-employer plan
2019-06-01Plan funding arrangement – TrustYes
2019-06-01Plan benefit arrangement – InsuranceYes
2018: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-06-01Type of plan entityMulti-employer plan
2018-06-01Plan is a collectively bargained planYes
2018-06-01Plan funding arrangement – TrustYes
2018-06-01Plan benefit arrangement – InsuranceYes
2017: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-06-01Type of plan entityMulti-employer plan
2017-06-01Plan is a collectively bargained planYes
2017-06-01Plan funding arrangement – TrustYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-06-01Type of plan entityMulti-employer plan
2016-06-01Plan is a collectively bargained planYes
2016-06-01Plan funding arrangement – TrustYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-06-01Type of plan entityMulti-employer plan
2015-06-01Plan is a collectively bargained planYes
2015-06-01Plan funding arrangement – TrustYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-06-01Type of plan entityMulti-employer plan
2014-06-01Plan is a collectively bargained planYes
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-06-01Type of plan entityMulti-employer plan
2013-06-01Plan is a collectively bargained planYes
2013-06-01Plan funding arrangement – TrustYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-06-01Type of plan entityMulti-employer plan
2012-06-01Plan is a collectively bargained planYes
2012-06-01Plan funding arrangement – TrustYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-06-01Type of plan entityMulti-employer plan
2011-06-01Plan is a collectively bargained planYes
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2009: LOCAL 665 I.A.T.S.E. HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-06-01Type of plan entityMulti-employer plan
2009-06-01This submission is the final filingNo
2009-06-01Plan is a collectively bargained planYes
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered987
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $2,912
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,912
Insurance broker organization code?3
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered807
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered398
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154
Policy instance 3
Insurance contract or identification number40154
Number of Individuals Covered493
Insurance policy start date2021-06-01
Insurance policy end date2022-05-30
Total amount of commissions paid to insurance brokerUSD $1,795
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT ADD
Welfare Benefit Premiums Paid to CarrierUSD $17,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,795
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575
Policy instance 2
Insurance contract or identification number3575
Number of Individuals Covered174
Insurance policy start date2021-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,090,053
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 number3575
Policy instance 2
Insurance contract or identification number3575
Number of Individuals Covered140
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $806,464
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered321
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154
Policy instance 3
Insurance contract or identification number40154
Number of Individuals Covered436
Insurance policy start date2020-06-01
Insurance policy end date2021-05-30
Total amount of commissions paid to insurance brokerUSD $1,640
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT ADD
Welfare Benefit Premiums Paid to CarrierUSD $15,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,640
Insurance broker organization code?3
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered730
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Health Insurance Welfare BenefitYes
HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered888
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $2,474
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,474
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575
Policy instance 2
Insurance contract or identification number3575
Number of Individuals Covered129
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $768,183
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered321
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154
Policy instance 3
Insurance contract or identification number40154
Number of Individuals Covered381
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,528
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT ADD
Welfare Benefit Premiums Paid to CarrierUSD $14,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,528
Insurance broker organization code?3
HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered784
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $2,161
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,161
Insurance broker organization code?3
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered650
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Health Insurance Welfare BenefitYes
HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered729
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,991
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,991
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575
Policy instance 2
Insurance contract or identification number3575
Number of Individuals Covered134
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $629,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154-100
Policy instance 3
Insurance contract or identification number40154-100
Number of Individuals Covered358
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,342
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,342
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered300
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered595
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered513
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered631
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $1,793
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
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 number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered105
Insurance policy start date2016-07-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $582,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154-100
Policy instance 3
Insurance contract or identification number40154-100
Number of Individuals Covered280
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $1,329
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,760
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered275
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered205
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154
Policy instance 3
Insurance contract or identification number40154
Number of Individuals Covered234
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,106
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,106
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS,INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered89
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $449,890
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: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS, INC
HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered619
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,705
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,705
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered126
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $486,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154
Policy instance 3
Insurance contract or identification number40154
Number of Individuals Covered240
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,242
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,242
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS,INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered254
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered453
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered234
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered484
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract number40154
Policy instance 3
Insurance contract or identification number40154
Number of Individuals Covered286
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,258
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,258
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS,INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered114
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $472,983
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: 00000 )
Policy contract number1713
Policy instance 1
Insurance contract or identification number1713
Number of Individuals Covered566
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,701
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,701
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS, INC
HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGRP#1713
Policy instance 1
Insurance contract or identification numberGRP#1713
Number of Individuals Covered566
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,701
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,701
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN SOLUTIONS, INC
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered459
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered234
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract numberGL-40154
Policy instance 3
Insurance contract or identification numberGL-40154
Number of Individuals Covered286
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,258
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,258
Insurance broker organization code?3
Insurance broker nameBENEFIT PLAN CONSULTANTS HI, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered114
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $472,983
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: 00000 )
Policy contract numberGRP#1713
Policy instance 1
Insurance contract or identification numberGRP#1713
Number of Individuals Covered683
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $1,859
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered149
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $499,149
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered275
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 5
Insurance contract or identification number8432
Number of Individuals Covered468
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract numberGL-40154
Policy instance 3
Insurance contract or identification numberGL-40154
Number of Individuals Covered273
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,344
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,054
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: 00000 )
Policy contract numberGRP#1713
Policy instance 1
Insurance contract or identification numberGRP#1713
Number of Individuals Covered570
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $1,265
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. (National Association of Insurance Commissioners NAIC id number: 64343 )
Policy contract numberGL-40154
Policy instance 3
Insurance contract or identification numberGL-40154
Number of Individuals Covered325
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,259
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,880
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 number30014658
Policy instance 4
Insurance contract or identification number30014658
Number of Individuals Covered213
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number01528H
Policy instance 5
Insurance contract or identification number01528H
Number of Individuals Covered390
Insurance policy start date2010-04-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $11,405
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $228,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )
Policy contract number8432
Policy instance 6
Insurance contract or identification number8432
Number of Individuals Covered528
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number3575/001/002/10
Policy instance 2
Insurance contract or identification number3575/001/002/10
Number of Individuals Covered172
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $442,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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