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GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 401k Plan overview

Plan NameGROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY
Plan identification number 501

GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY Benefits

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

401k Sponsoring company profile

GENUINE PARTS COMPANY has sponsored the creation of one or more 401k plans.

Company Name:GENUINE PARTS COMPANY
Employer identification number (EIN):580254510
NAIC Classification:423100

Additional information about GENUINE PARTS COMPANY

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1938-06-01
Company Identification Number: 136065

More information about GENUINE PARTS COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01CHARLIE CHESNUTT
5012017-01-01CHARLIE CHESNUTT
5012016-01-01CHARLIE CHESNUTT
5012015-01-01CHARLIE CHESNUTT
5012014-01-01FRANK M. HOWARD
5012013-01-01FRANK M. HOWARD FRANK M. HOWARD2014-07-24
5012012-01-01FRANK M. HOWARD FRANK M. HOWARD2013-07-25
5012011-01-01FRANK M. HOWARD FRANK M. HOWARD2012-07-24
5012010-01-01FRANK M. HOWARD FRANK M. HOWARD2011-07-22
5012009-01-01FRANK HOWARD FRANK M. HOWARD2010-07-30

Plan Statistics for GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

401k plan membership statisitcs for GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

Measure Date Value
2023: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2023 401k membership
Total participants, beginning-of-year2023-01-0121,967
Total number of active participants reported on line 7a of the Form 55002023-01-0129,777
Number of retired or separated participants receiving benefits2023-01-01209
Number of other retired or separated participants entitled to future benefits2023-01-01575
Total of all active and inactive participants2023-01-0130,561
Total participants2023-01-0130,561
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2022 401k membership
Total participants, beginning-of-year2022-01-0119,922
Total number of active participants reported on line 7a of the Form 55002022-01-0121,780
Number of retired or separated participants receiving benefits2022-01-01187
Total of all active and inactive participants2022-01-0121,967
Total participants2022-01-0121,967
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2021 401k membership
Total participants, beginning-of-year2021-01-0122,408
Total number of active participants reported on line 7a of the Form 55002021-01-0119,750
Number of retired or separated participants receiving benefits2021-01-01172
Total of all active and inactive participants2021-01-0119,922
Total participants2021-01-0119,922
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2020 401k membership
Total participants, beginning-of-year2020-01-0124,366
Total number of active participants reported on line 7a of the Form 55002020-01-0121,716
Number of retired or separated participants receiving benefits2020-01-01692
Total of all active and inactive participants2020-01-0122,408
Total participants2020-01-0122,408
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2019 401k membership
Total participants, beginning-of-year2019-01-0124,143
Total number of active participants reported on line 7a of the Form 55002019-01-0123,461
Number of retired or separated participants receiving benefits2019-01-01905
Total of all active and inactive participants2019-01-0124,366
Total participants2019-01-0124,366
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2018 401k membership
Total participants, beginning-of-year2018-01-0123,646
Total number of active participants reported on line 7a of the Form 55002018-01-0123,311
Number of retired or separated participants receiving benefits2018-01-01832
Total of all active and inactive participants2018-01-0124,143
Total participants2018-01-0124,143
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2017 401k membership
Total participants, beginning-of-year2017-01-0122,828
Total number of active participants reported on line 7a of the Form 55002017-01-0122,679
Number of retired or separated participants receiving benefits2017-01-01967
Total of all active and inactive participants2017-01-0123,646
Total participants2017-01-0123,646
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2016 401k membership
Total participants, beginning-of-year2016-01-0122,093
Total number of active participants reported on line 7a of the Form 55002016-01-0121,798
Number of retired or separated participants receiving benefits2016-01-011,030
Total of all active and inactive participants2016-01-0122,828
Total participants2016-01-0122,828
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2015 401k membership
Total participants, beginning-of-year2015-01-0121,798
Total number of active participants reported on line 7a of the Form 55002015-01-0121,059
Number of retired or separated participants receiving benefits2015-01-011,034
Total of all active and inactive participants2015-01-0122,093
Total participants2015-01-0122,093
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2014 401k membership
Total participants, beginning-of-year2014-01-0121,486
Total number of active participants reported on line 7a of the Form 55002014-01-0120,623
Number of retired or separated participants receiving benefits2014-01-011,175
Total of all active and inactive participants2014-01-0121,798
Total participants2014-01-0121,798
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2013 401k membership
Total participants, beginning-of-year2013-01-0121,604
Total number of active participants reported on line 7a of the Form 55002013-01-0120,134
Number of retired or separated participants receiving benefits2013-01-011,352
Total of all active and inactive participants2013-01-0121,486
Total participants2013-01-0121,486
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2012 401k membership
Total participants, beginning-of-year2012-01-0121,776
Total number of active participants reported on line 7a of the Form 55002012-01-0120,223
Number of retired or separated participants receiving benefits2012-01-011,381
Total of all active and inactive participants2012-01-0121,604
Total participants2012-01-0121,604
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2011 401k membership
Total participants, beginning-of-year2011-01-0122,349
Total number of active participants reported on line 7a of the Form 55002011-01-0120,271
Number of retired or separated participants receiving benefits2011-01-011,505
Total of all active and inactive participants2011-01-0121,776
Total participants2011-01-0121,776
2010: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2010 401k membership
Total participants, beginning-of-year2010-01-0124,048
Total number of active participants reported on line 7a of the Form 55002010-01-0120,442
Number of retired or separated participants receiving benefits2010-01-011,907
Total of all active and inactive participants2010-01-0122,349
Total participants2010-01-0122,349
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2009 401k membership
Total participants, beginning-of-year2009-01-0125,151
Total number of active participants reported on line 7a of the Form 55002009-01-0121,177
Number of retired or separated participants receiving benefits2009-01-012,871
Total of all active and inactive participants2009-01-0124,048
Total participants2009-01-0124,048

Form 5500 Responses for GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY

2023: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
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 number4828, 96613
Policy instance 2
Insurance contract or identification number4828, 96613
Number of Individuals Covered113
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,296,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered52
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $379,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number75587
Policy instance 7
Insurance contract or identification number75587
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Other welfare benefits providedSTATUTORY DISABILITY NY
Welfare Benefit Premiums Paid to CarrierUSD $346,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 3
Insurance contract or identification number9660952
Number of Individuals Covered27965
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,582,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681391G,S08931
Policy instance 4
Insurance contract or identification number681391G,S08931
Number of Individuals Covered30620
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of fees paid to insurance companyUSD $91,314
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,675,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number980335,980153
Policy instance 5
Insurance contract or identification number980335,980153
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,258,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B 03122D
Policy instance 6
Insurance contract or identification number03122B 03122D
Number of Individuals Covered3
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of fees paid to insurance companyUSD $11,236
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION
Welfare Benefit Premiums Paid to CarrierUSD $90,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered50
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $341,242
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 number4828, 96613
Policy instance 2
Insurance contract or identification number4828, 96613
Number of Individuals Covered90
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,345,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 3
Insurance contract or identification number9660952
Number of Individuals Covered27749
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,532,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number980335,980153
Policy instance 5
Insurance contract or identification number980335,980153
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,839,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B 03122D
Policy instance 6
Insurance contract or identification number03122B 03122D
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $284
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION
Welfare Benefit Premiums Paid to CarrierUSD $24,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $284
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number75587
Policy instance 7
Insurance contract or identification number75587
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedSTATUTORY DISABILITY NY
Welfare Benefit Premiums Paid to CarrierUSD $351,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681391G,S08931
Policy instance 4
Insurance contract or identification number681391G,S08931
Number of Individuals Covered25825
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $102,269
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,108,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees102269
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered54
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $357,970
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 number4828, 96613
Policy instance 2
Insurance contract or identification number4828, 96613
Number of Individuals Covered93
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,230,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 3
Insurance contract or identification number9660952
Number of Individuals Covered25440
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,666,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 4
Insurance contract or identification number03122B
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $5,748
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $57,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5748
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681391G,S08931
Policy instance 5
Insurance contract or identification number681391G,S08931
Number of Individuals Covered26965
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $102,845
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,777,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees102845
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number980335,980153
Policy instance 6
Insurance contract or identification number980335,980153
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $30,160
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $632,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees30160
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD075587
Policy instance 7
Insurance contract or identification numberNYD075587
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $1,338
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $72,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1338
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered54
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $374,748
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 number4828, 96613
Policy instance 2
Insurance contract or identification number4828, 96613
Number of Individuals Covered106
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,235,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 3
Insurance contract or identification number9660952
Number of Individuals Covered26726
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,501,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 4
Insurance contract or identification number03122B
Number of Individuals Covered5
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $16,415
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $164,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees16415
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681391G,S08931
Policy instance 5
Insurance contract or identification number681391G,S08931
Number of Individuals Covered22589
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $72,927
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,394,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees72927
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number980335,980153
Policy instance 6
Insurance contract or identification number980335,980153
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $31,863
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,907,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees31863
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD075587
Policy instance 7
Insurance contract or identification numberNYD075587
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $1,016
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $151,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1016
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered49
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $315,196
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 number4828, 96613
Policy instance 2
Insurance contract or identification number4828, 96613
Number of Individuals Covered114
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,338,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 3
Insurance contract or identification number261,566,720,772
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $10,000
Total amount of fees paid to insurance companyUSD $11,003
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $186,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11003
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $10,000
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 5
Insurance contract or identification number03122B
Number of Individuals Covered5
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13,759
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $137,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,759
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 4
Insurance contract or identification number9660952
Number of Individuals Covered31924
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,593,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681391G,S08931
Policy instance 6
Insurance contract or identification number681391G,S08931
Number of Individuals Covered26724
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $67,302
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,158,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees67302
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number980335,980153
Policy instance 7
Insurance contract or identification number980335,980153
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $70,958
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,906,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees70958
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD075587
Policy instance 8
Insurance contract or identification numberNYD075587
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $681
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $102,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees681
Additional information about fees paid to insurance brokerOVERRIDE
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered25008
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $81,951
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,146,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,951
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered133
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,312,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered20138
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $80,000
Total amount of fees paid to insurance companyUSD $59,110
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $4,635,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees59018
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $80,000
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered31729
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,714,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $8,039
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $104,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,039
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered37
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered11
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $73,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered49
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $291,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered24919
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $167,215
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,866,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $167,215
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA INC
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered137
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,190,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered20898
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $40,000
Total amount of fees paid to insurance companyUSD $68,290
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $4,277,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,000
Amount paid for insurance broker fees68290
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON DELAWARE INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered31154
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,803,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered53
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $287,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered21059
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $50,000
Total amount of fees paid to insurance companyUSD $56,356
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $3,640,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,000
Amount paid for insurance broker fees56325
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered21059
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,467,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered3
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $57,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered23489
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $73,788
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,586,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,788
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA INC
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered140
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $864,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $53,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered20623
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $115,000
Total amount of fees paid to insurance companyUSD $90,939
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $3,352,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $115,000
Amount paid for insurance broker fees90939
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered20623
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,448,613
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 number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered136
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $806,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered22884
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $70,091
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,561,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,091
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered51
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered20048
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $3,458,537
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 number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered136
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $834,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered53
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $275,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered22423
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $446
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,684,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $446
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA INC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $82,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered20134
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,677,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered21438
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $47,060
Total amount of fees paid to insurance companyUSD $46,577
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?Yes
Welfare Benefit Premiums Paid to CarrierUSD $4,719,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,060
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Amount paid for insurance broker fees46577
Insurance broker nameDG3 NORTH AMERICA INC.
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered142
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $949,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered18903
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $3,896,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered20223
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,388,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered60
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $324,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered4
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $72,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered82
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $282,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered16399
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $22,537
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,657,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number03122B
Policy instance 6
Insurance contract or identification number03122B
Number of Individuals Covered3
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $60,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered20271
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,477,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered18585
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $4,463,213
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 number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered140
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number03122A
Policy instance 6
Insurance contract or identification number03122A
Number of Individuals Covered5
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
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $122,923
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number261,566,720,772
Policy instance 4
Insurance contract or identification number261,566,720,772
Number of Individuals Covered19535
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
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $4,286,435
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number749521,2,3,4,56
Policy instance 2
Insurance contract or identification number749521,2,3,4,56
Number of Individuals Covered22349
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $87,353
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,438,222
Commission paid to Insurance BrokerUSD $87,353
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA INC
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number4828, 96613
Policy instance 3
Insurance contract or identification number4828, 96613
Number of Individuals Covered148
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,123,024
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1166/10
Policy instance 1
Insurance contract or identification number1166/10
Number of Individuals Covered68
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $220,661
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9660952
Policy instance 5
Insurance contract or identification number9660952
Number of Individuals Covered22349
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,441,070

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