HIE HOLDINGS, INC. has sponsored the creation of one or more 401k plans.
Additional information about HIE HOLDINGS, INC.
Submission information for form 5500 for 401k plan MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC.
401k plan membership statisitcs for MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC.
Measure | Date | Value |
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2021: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 162 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 103 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 1 |
Total of all active and inactive participants | 2021-01-01 | 104 |
2020: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 164 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 127 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 1 |
Total of all active and inactive participants | 2020-01-01 | 128 |
2019: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 183 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 133 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 1 |
Total of all active and inactive participants | 2019-01-01 | 134 |
2018: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 194 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 151 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 2 |
Total of all active and inactive participants | 2018-01-01 | 153 |
2017: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 197 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 159 |
Total of all active and inactive participants | 2017-01-01 | 159 |
2016: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 404 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 382 |
Total of all active and inactive participants | 2016-01-01 | 382 |
2015: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 383 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 404 |
Total of all active and inactive participants | 2015-01-01 | 404 |
2014: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 622 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 383 |
Total of all active and inactive participants | 2014-01-01 | 383 |
2013: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 616 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 622 |
Total of all active and inactive participants | 2013-01-01 | 622 |
2012: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 625 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 616 |
Total of all active and inactive participants | 2012-01-01 | 616 |
2011: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 362 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 625 |
Total of all active and inactive participants | 2011-01-01 | 625 |
2010: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 595 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 362 |
Total of all active and inactive participants | 2010-01-01 | 362 |
2009: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 561 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 595 |
Total of all active and inactive participants | 2009-01-01 | 595 |
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 3 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 133 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,312 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30067971 |
Policy instance | 2 |
Insurance contract or identification number | 30067971 | Number of Individuals Covered | 97 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,706 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 ) |
Policy contract number | 56522 |
Policy instance | 1 |
Insurance contract or identification number | 56522 | Number of Individuals Covered | 122 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $24,779 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $827,324 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 24779 | Insurance broker organization code? | 3 |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 3 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 176 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $67,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30067971 |
Policy instance | 2 |
Insurance contract or identification number | 30067971 | Number of Individuals Covered | 113 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 ) |
Policy contract number | 56522 |
Policy instance | 1 |
Insurance contract or identification number | 56522 | Number of Individuals Covered | 162 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $27,518 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $936,332 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,518 | Insurance broker organization code? | 3 |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 3 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 187 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $73,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 ) |
Policy contract number | 56522 |
Policy instance | 1 |
Insurance contract or identification number | 56522 | Number of Individuals Covered | 164 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $27,637 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $922,162 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,637 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30067971 |
Policy instance | 2 |
Insurance contract or identification number | 30067971 | Number of Individuals Covered | 130 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,750 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
Policy contract number | 1600-0025 |
Policy instance | 1 |
Insurance contract or identification number | 1600-0025 | Number of Individuals Covered | 183 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $20,707 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,707 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30067971 |
Policy instance | 2 |
Insurance contract or identification number | 30067971 | Number of Individuals Covered | 145 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,813 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 3 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 203 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $79,155 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30067971 |
Policy instance | 2 |
Insurance contract or identification number | 30067971 | Number of Individuals Covered | 156 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,946 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 3 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 214 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $79,927 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
Policy contract number | 1600-0025 |
Policy instance | 1 |
Insurance contract or identification number | 1600-0025 | Number of Individuals Covered | 194 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $27,317 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,317 | Insurance broker organization code? | 3 | Insurance broker name | PACIFIC BUSINESS SOLUTIONS, LLC. |
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FAMILY HEATH HAWAII (National Association of Insurance Commissioners NAIC id number: 15074 ) |
Policy contract number | 1400035 |
Policy instance | 2 |
Insurance contract or identification number | 1400035 | Number of Individuals Covered | 185 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $918,048 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 1 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 219 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,519 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FAMILY HEATH HAWAII (National Association of Insurance Commissioners NAIC id number: 15074 ) |
Policy contract number | 1400035 |
Policy instance | 4 |
Insurance contract or identification number | 1400035 | Number of Individuals Covered | 171 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $464,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 21092 |
Policy instance | 3 |
Insurance contract or identification number | 21092 | Number of Individuals Covered | 0 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2014-07-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 2 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 212 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,114 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12049037 |
Policy instance | 1 |
Insurance contract or identification number | 12049037 | Number of Individuals Covered | 0 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-07-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,803 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 2 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 229 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $74,027 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12049037 |
Policy instance | 1 |
Insurance contract or identification number | 12049037 | Number of Individuals Covered | 174 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,995 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 21092 |
Policy instance | 3 |
Insurance contract or identification number | 21092 | Number of Individuals Covered | 219 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,011,948 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12049037 |
Policy instance | 1 |
Insurance contract or identification number | 12049037 | Number of Individuals Covered | 166 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,422 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 2 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 231 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $70,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 3 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 219 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $925,195 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) |
Policy contract number | 17395 |
Policy instance | 4 |
Insurance contract or identification number | 17395 | Number of Individuals Covered | 224 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $67,483 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 12804 |
Policy instance | 2 |
Insurance contract or identification number | 12804 | Number of Individuals Covered | 43 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | HOSPITALIZATION & SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $162,287 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
Policy contract number | 4054 |
Policy instance | 1 |
Insurance contract or identification number | 4054 | Number of Individuals Covered | 185 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $22,390 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12049037 |
Policy instance | 3 |
Insurance contract or identification number | 12049037 | Number of Individuals Covered | 173 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,357 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 12804 |
Policy instance | 2 |
Insurance contract or identification number | 12804 | Number of Individuals Covered | 41 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | HOSPITALIZATION & SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $126,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 2761 |
Policy instance | 3 |
Insurance contract or identification number | 2761 | Number of Individuals Covered | 0 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,891 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12049037 |
Policy instance | 4 |
Insurance contract or identification number | 12049037 | Number of Individuals Covered | 177 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $20,481 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
Policy contract number | 4054 |
Policy instance | 1 |
Insurance contract or identification number | 4054 | Number of Individuals Covered | 144 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $19,744 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,744 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker name | CHARTER PACIFIC & ASSOCIATES |
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