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MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 401k Plan overview

Plan NameMEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC.
Plan identification number 501

MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. Benefits

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

401k Sponsoring company profile

HIE HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:HIE HOLDINGS, INC.
Employer identification number (EIN):990311680
NAIC Classification:311900
NAIC Description: Other Food Manufacturing

Additional information about HIE HOLDINGS, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 4674266

More information about HIE HOLDINGS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01KENNETH MITO KENNETH MITO2018-10-09
5012016-01-01KENNETH MITO KENNETH MITO2017-10-11
5012015-01-01MORRIS MIYASATO MORRIS MIYASATO2016-07-20
5012014-01-01MORRIS MIYASATO MORRIS MIYASATO2015-09-24
5012013-01-01MORRIS MIYASATO MORRIS MIYASATO2014-10-07
5012012-01-01MORRIS MIYASATO MORRIS MIYASATO2013-10-15
5012011-01-01MORRIS MIYASATO MORRIS MIYASATO2012-10-15
5012010-01-01MORRIS MIYASATO MORRIS MIYASATO2011-10-14
5012009-01-01MORRIS MIYASATO MORRIS MIYASATO2010-10-15

Plan Statistics for 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
2021: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01162
Total number of active participants reported on line 7a of the Form 55002021-01-01103
Number of retired or separated participants receiving benefits2021-01-011
Total of all active and inactive participants2021-01-01104
2020: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-01164
Total number of active participants reported on line 7a of the Form 55002020-01-01127
Number of retired or separated participants receiving benefits2020-01-011
Total of all active and inactive participants2020-01-01128
2019: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01183
Total number of active participants reported on line 7a of the Form 55002019-01-01133
Number of retired or separated participants receiving benefits2019-01-011
Total of all active and inactive participants2019-01-01134
2018: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01194
Total number of active participants reported on line 7a of the Form 55002018-01-01151
Number of retired or separated participants receiving benefits2018-01-012
Total of all active and inactive participants2018-01-01153
2017: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2017 401k membership
Total participants, beginning-of-year2017-01-01197
Total number of active participants reported on line 7a of the Form 55002017-01-01159
Total of all active and inactive participants2017-01-01159
2016: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2016 401k membership
Total participants, beginning-of-year2016-01-01404
Total number of active participants reported on line 7a of the Form 55002016-01-01382
Total of all active and inactive participants2016-01-01382
2015: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2015 401k membership
Total participants, beginning-of-year2015-01-01383
Total number of active participants reported on line 7a of the Form 55002015-01-01404
Total of all active and inactive participants2015-01-01404
2014: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2014 401k membership
Total participants, beginning-of-year2014-01-01622
Total number of active participants reported on line 7a of the Form 55002014-01-01383
Total of all active and inactive participants2014-01-01383
2013: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2013 401k membership
Total participants, beginning-of-year2013-01-01616
Total number of active participants reported on line 7a of the Form 55002013-01-01622
Total of all active and inactive participants2013-01-01622
2012: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01625
Total number of active participants reported on line 7a of the Form 55002012-01-01616
Total of all active and inactive participants2012-01-01616
2011: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2011 401k membership
Total participants, beginning-of-year2011-01-01362
Total number of active participants reported on line 7a of the Form 55002011-01-01625
Total of all active and inactive participants2011-01-01625
2010: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2010 401k membership
Total participants, beginning-of-year2010-01-01595
Total number of active participants reported on line 7a of the Form 55002010-01-01362
Total of all active and inactive participants2010-01-01362
2009: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2009 401k membership
Total participants, beginning-of-year2009-01-01561
Total number of active participants reported on line 7a of the Form 55002009-01-01595
Total of all active and inactive participants2009-01-01595

Form 5500 Responses for MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC.

2021: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: MEDICAL PLAN FOR THE EMPLOYEES OF HIE HOLDINGS, INC. 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 3
Insurance contract or identification number17395
Number of Individuals Covered133
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,312
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 number30067971
Policy instance 2
Insurance contract or identification number30067971
Number of Individuals Covered97
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,706
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 number56522
Policy instance 1
Insurance contract or identification number56522
Number of Individuals Covered122
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $24,779
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 fees24779
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 3
Insurance contract or identification number17395
Number of Individuals Covered176
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,971
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 number30067971
Policy instance 2
Insurance contract or identification number30067971
Number of Individuals Covered113
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,375
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 number56522
Policy instance 1
Insurance contract or identification number56522
Number of Individuals Covered162
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $27,518
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $936,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,518
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 3
Insurance contract or identification number17395
Number of Individuals Covered187
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,288
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 number56522
Policy instance 1
Insurance contract or identification number56522
Number of Individuals Covered164
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $27,637
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $922,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,637
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30067971
Policy instance 2
Insurance contract or identification number30067971
Number of Individuals Covered130
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,750
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 number1600-0025
Policy instance 1
Insurance contract or identification number1600-0025
Number of Individuals Covered183
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $20,707
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 $20,707
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30067971
Policy instance 2
Insurance contract or identification number30067971
Number of Individuals Covered145
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 3
Insurance contract or identification number17395
Number of Individuals Covered203
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,155
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 number30067971
Policy instance 2
Insurance contract or identification number30067971
Number of Individuals Covered156
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 3
Insurance contract or identification number17395
Number of Individuals Covered214
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
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,927
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 number1600-0025
Policy instance 1
Insurance contract or identification number1600-0025
Number of Individuals Covered194
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $27,317
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 $27,317
Insurance broker organization code?3
Insurance broker namePACIFIC BUSINESS SOLUTIONS, LLC.
FAMILY HEATH HAWAII (National Association of Insurance Commissioners NAIC id number: 15074 )
Policy contract number1400035
Policy instance 2
Insurance contract or identification number1400035
Number of Individuals Covered185
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $918,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 1
Insurance contract or identification number17395
Number of Individuals Covered219
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FAMILY HEATH HAWAII (National Association of Insurance Commissioners NAIC id number: 15074 )
Policy contract number1400035
Policy instance 4
Insurance contract or identification number1400035
Number of Individuals Covered171
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $464,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number21092
Policy instance 3
Insurance contract or identification number21092
Number of Individuals Covered0
Insurance policy start date2014-07-01
Insurance policy end date2014-07-01
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
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 2
Insurance contract or identification number17395
Number of Individuals Covered212
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
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 $77,114
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 number12049037
Policy instance 1
Insurance contract or identification number12049037
Number of Individuals Covered0
Insurance policy start date2014-01-01
Insurance policy end date2014-07-01
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
Welfare Benefit Premiums Paid to CarrierUSD $9,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 2
Insurance contract or identification number17395
Number of Individuals Covered229
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
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,027
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 number12049037
Policy instance 1
Insurance contract or identification number12049037
Number of Individuals Covered174
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number21092
Policy instance 3
Insurance contract or identification number21092
Number of Individuals Covered219
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 $1,011,948
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 number12049037
Policy instance 1
Insurance contract or identification number12049037
Number of Individuals Covered166
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 2
Insurance contract or identification number17395
Number of Individuals Covered231
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
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 3
Insurance contract or identification number17395
Number of Individuals Covered219
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 $925,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number17395
Policy instance 4
Insurance contract or identification number17395
Number of Individuals Covered224
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $67,483
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 number12804
Policy instance 2
Insurance contract or identification number12804
Number of Individuals Covered43
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHOSPITALIZATION & SURGICAL
Welfare Benefit Premiums Paid to CarrierUSD $162,287
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 number4054
Policy instance 1
Insurance contract or identification number4054
Number of Individuals Covered185
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $22,390
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 number12049037
Policy instance 3
Insurance contract or identification number12049037
Number of Individuals Covered173
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,357
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 number12804
Policy instance 2
Insurance contract or identification number12804
Number of Individuals Covered41
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHOSPITALIZATION & SURGICAL
Welfare Benefit Premiums Paid to CarrierUSD $126,384
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 number2761
Policy instance 3
Insurance contract or identification number2761
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $42,891
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 number12049037
Policy instance 4
Insurance contract or identification number12049037
Number of Individuals Covered177
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $20,481
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 number4054
Policy instance 1
Insurance contract or identification number4054
Number of Individuals Covered144
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $19,744
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
Commission paid to Insurance BrokerUSD $19,744
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker nameCHARTER PACIFIC & ASSOCIATES

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