ACUITY BRANDS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC.
401k plan membership statisitcs for EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC.
| 2022: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Submission has been amended | Yes |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: EMPLOYEE GROUP INSURANCE BENEFITS PLAN OF ACUITY BRANDS,INC. 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 132734 |
| Policy instance | 2 |
| Insurance contract or identification number | 132734 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $910,572 | | 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: 71870 ) |
| Policy contract number | 97505301001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97505301001 | | Number of Individuals Covered | 4193 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $11,563 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $253,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,563 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 17683 |
| Policy instance | 11 |
| Insurance contract or identification number | 17683 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $19,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 102775 |
| Policy instance | 3 |
| Insurance contract or identification number | 102775 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $966,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 658661 |
| Policy instance | 4 |
| Insurance contract or identification number | 658661 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $710,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 702698-EAP |
| Policy instance | 5 |
| Insurance contract or identification number | 702698-EAP | | Number of Individuals Covered | 12402 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $152,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 ) |
| Policy contract number | 18927-001 & 002 |
| Policy instance | 6 |
| Insurance contract or identification number | 18927-001 & 002 | | Number of Individuals Covered | 780 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $7,267 | | Other welfare benefits provided | LEGAL PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $63,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,267 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0157692 |
| Policy instance | 7 |
| Insurance contract or identification number | 0157692 | | Number of Individuals Covered | 4950 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $98,323 | | Total amount of fees paid to insurance company | USD $68 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,963,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $98,323 | | Amount paid for insurance broker fees | 68 | | Additional information about fees paid to insurance broker | ADDL FEES - NON MONETARY COMPENSATI | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10162241001 |
| Policy instance | 8 |
| Insurance contract or identification number | 10162241001 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $1,044 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,044 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 408182-0010 |
| Policy instance | 9 |
| Insurance contract or identification number | 408182-0010 | | Number of Individuals Covered | 2467 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $145,663 | | Welfare Benefit Premiums Paid to Carrier | USD $2,427,725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $145,663 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 390050 |
| Policy instance | 10 |
| Insurance contract or identification number | 390050 | | Number of Individuals Covered | 3152 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $58,227 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | HOSPITAL INDEMN;CRITIC ILL;ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $178,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,227 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 702698-EAP |
| Policy instance | 5 |
| Insurance contract or identification number | 702698-EAP | | Number of Individuals Covered | 13016 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $253,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 658661 |
| Policy instance | 4 |
| Insurance contract or identification number | 658661 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,024,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 102775 |
| Policy instance | 3 |
| Insurance contract or identification number | 102775 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,068,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 132734 |
| Policy instance | 2 |
| Insurance contract or identification number | 132734 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $992,520 | | 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: 71870 ) |
| Policy contract number | 97505301001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97505301001 | | Number of Individuals Covered | 4281 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $14,850 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $275,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,850 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0157692 |
| Policy instance | 8 |
| Insurance contract or identification number | 0157692 | | Number of Individuals Covered | 5017 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $99,077 | | Total amount of fees paid to insurance company | USD $146 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,993,126 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99,077 | | Amount paid for insurance broker fees | 146 | | Additional information about fees paid to insurance broker | ADDL FEES - NON MONETARY COMPENSATI & MARKETING FEES | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012483-000 |
| Policy instance | 6 |
| Insurance contract or identification number | 16-012483-000 | | Number of Individuals Covered | 2441 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $111,804 | | Welfare Benefit Premiums Paid to Carrier | USD $2,376,075 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111,804 | | Insurance broker organization code? | 3 |
|
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1500855 |
| Policy instance | 7 |
| Insurance contract or identification number | 1500855 | | Number of Individuals Covered | 375 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $7,258 | | Total amount of fees paid to insurance company | USD $67 | | Other welfare benefits provided | GROUP LEGAL PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $72,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,258 | | Amount paid for insurance broker fees | 67 | | Additional information about fees paid to insurance broker | ADDL FEES - NON-MONETARY COMPENSATI | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 17683 |
| Policy instance | 13 |
| Insurance contract or identification number | 17683 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $50 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 50 | | Additional information about fees paid to insurance broker | BONUS COMMISSIONS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961105 |
| Policy instance | 12 |
| Insurance contract or identification number | AI961105 | | Number of Individuals Covered | 954 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $7,308 | | Total amount of fees paid to insurance company | USD $459 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $146,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,964 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 459 | | Additional information about fees paid to insurance broker | COMMISSION OVERRIDES |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961061 |
| Policy instance | 11 |
| Insurance contract or identification number | CI961061 | | Number of Individuals Covered | 1511 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $10,761 | | Total amount of fees paid to insurance company | USD $642 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $215,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,315 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 642 | | Additional information about fees paid to insurance broker | COMMISSION OVERRIDES |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | HC960475 |
| Policy instance | 10 |
| Insurance contract or identification number | HC960475 | | Number of Individuals Covered | 667 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $9,007 | | Total amount of fees paid to insurance company | USD $618 | | Other welfare benefits provided | HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $180,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,066 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 618 | | Additional information about fees paid to insurance broker | COMMISSION OVERRIDES |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10162241001 |
| Policy instance | 9 |
| Insurance contract or identification number | 10162241001 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,908 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 102775 |
| Policy instance | 3 |
| Insurance contract or identification number | 102775 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,046,081 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 658661 |
| Policy instance | 4 |
| Insurance contract or identification number | 658661 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,051,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 702698-EAP |
| Policy instance | 5 |
| Insurance contract or identification number | 702698-EAP | | Number of Individuals Covered | 11866 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $218,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012483-000 |
| Policy instance | 6 |
| Insurance contract or identification number | 16-012483-000 | | Number of Individuals Covered | 2568 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $90,268 | | Welfare Benefit Premiums Paid to Carrier | USD $1,805,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $90,268 | | Insurance broker organization code? | 3 |
|
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1500855 |
| Policy instance | 7 |
| Insurance contract or identification number | 1500855 | | Number of Individuals Covered | 387 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $7,154 | | Total amount of fees paid to insurance company | USD $24 | | Other welfare benefits provided | GROUP LEGAL PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $71,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,154 | | Amount paid for insurance broker fees | 24 | | Additional information about fees paid to insurance broker | ADDL FEES - NON-MONETARY COMPENSATI | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0157692 |
| Policy instance | 8 |
| Insurance contract or identification number | 0157692 | | Number of Individuals Covered | 5147 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $98,576 | | Total amount of fees paid to insurance company | USD $42 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,106,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $98,576 | | Amount paid for insurance broker fees | 42 | | Additional information about fees paid to insurance broker | ADDL FEES - NON MONETARY COMPENSATI & MARKETING FEES | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10162241001 |
| Policy instance | 9 |
| Insurance contract or identification number | 10162241001 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,601 | | 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: 65498 ) |
| Policy contract number | CI961061 |
| Policy instance | 11 |
| Insurance contract or identification number | CI961061 | | Number of Individuals Covered | 1524 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $21,310 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $219,208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,310 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961105 |
| Policy instance | 12 |
| Insurance contract or identification number | AI961105 | | Number of Individuals Covered | 1008 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $13,843 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $137,328 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,843 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 132734 |
| Policy instance | 2 |
| Insurance contract or identification number | 132734 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $833,687 | | 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: 71870 ) |
| Policy contract number | 97505301001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97505301001 | | Number of Individuals Covered | 4394 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $12,351 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $271,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,351 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | HC960475 |
| Policy instance | 10 |
| Insurance contract or identification number | HC960475 | | Number of Individuals Covered | 693 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $14,693 | | Other welfare benefits provided | HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $156,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,693 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 97505301001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97505301001 | | Number of Individuals Covered | 4650 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $15,646 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $291,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,646 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 132734 |
| Policy instance | 2 |
| Insurance contract or identification number | 132734 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $832,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 102775 |
| Policy instance | 3 |
| Insurance contract or identification number | 102775 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $873,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 658661 |
| Policy instance | 4 |
| Insurance contract or identification number | 658661 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,092,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 702698-EAP |
| Policy instance | 5 |
| Insurance contract or identification number | 702698-EAP | | Number of Individuals Covered | 11619 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $215,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012483-000 |
| Policy instance | 6 |
| Insurance contract or identification number | 16-012483-000 | | Number of Individuals Covered | 2752 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $87,052 | | Welfare Benefit Premiums Paid to Carrier | USD $1,741,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,052 | | Insurance broker organization code? | 3 |
|
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1500855 |
| Policy instance | 7 |
| Insurance contract or identification number | 1500855 | | Number of Individuals Covered | 355 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $6,886 | | Total amount of fees paid to insurance company | USD $42 | | Other welfare benefits provided | GROUP LEGAL PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $74,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,886 | | Amount paid for insurance broker fees | 42 | | Additional information about fees paid to insurance broker | ADDL FEES - NON-MONETARY COMPENSATI | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961105 |
| Policy instance | 12 |
| Insurance contract or identification number | AI961105 | | Number of Individuals Covered | 1729 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $92,636 | | Other welfare benefits provided | ACCINDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $142,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $92,636 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961061 |
| Policy instance | 11 |
| Insurance contract or identification number | CI961061 | | Number of Individuals Covered | 1552 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $136,433 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $209,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $136,433 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | HC960475 |
| Policy instance | 10 |
| Insurance contract or identification number | HC960475 | | Number of Individuals Covered | 836 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $86,560 | | Other welfare benefits provided | HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $133,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $86,560 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10162241001 |
| Policy instance | 9 |
| Insurance contract or identification number | 10162241001 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,692 | | 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 number | 0157692 |
| Policy instance | 8 |
| Insurance contract or identification number | 0157692 | | Number of Individuals Covered | 5528 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $119,817 | | Total amount of fees paid to insurance company | USD $138 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,221,466 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $119,817 | | Amount paid for insurance broker fees | 138 | | Additional information about fees paid to insurance broker | ADDL FEES - NON MONETARY COMPENSATI & MARKETING FEES | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 97505301001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97505301001 | | Number of Individuals Covered | 4872 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $13,105 | | Total amount of fees paid to insurance company | USD $46 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $285,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,105 | | Amount paid for insurance broker fees | 46 | | Additional information about fees paid to insurance broker | MGTF | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 132734 |
| Policy instance | 2 |
| Insurance contract or identification number | 132734 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,054 | | Welfare Benefit Premiums Paid to Carrier | USD $607,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,054 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 102775 |
| Policy instance | 3 |
| Insurance contract or identification number | 102775 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $805,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 658661 |
| Policy instance | 4 |
| Insurance contract or identification number | 658661 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $801,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 702698-EAP |
| Policy instance | 5 |
| Insurance contract or identification number | 702698-EAP | | Number of Individuals Covered | 11787 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $242,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012483-000 |
| Policy instance | 6 |
| Insurance contract or identification number | 16-012483-000 | | Number of Individuals Covered | 2809 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $65,886 | | Welfare Benefit Premiums Paid to Carrier | USD $1,317,711 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $65,886 | | Insurance broker organization code? | 3 |
|
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1500855 |
| Policy instance | 7 |
| Insurance contract or identification number | 1500855 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $6,254 | | Total amount of fees paid to insurance company | USD $70 | | Other welfare benefits provided | GROUP LEGAL PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $56,036 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,254 | | Amount paid for insurance broker fees | 70 | | Additional information about fees paid to insurance broker | ADDL FEES - NON-MONETARY COMPENSATI | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V2820 |
| Policy instance | 8 |
| Insurance contract or identification number | V2820 | | Number of Individuals Covered | 724 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $71,073 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT & CRITICAL ILLINESS | | Welfare Benefit Premiums Paid to Carrier | USD $264,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $71,073 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V3209 |
| Policy instance | 9 |
| Insurance contract or identification number | V3209 | | Number of Individuals Covered | 315 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $21,729 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT & CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $149,586 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,729 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0157692 |
| Policy instance | 10 |
| Insurance contract or identification number | 0157692 | | Number of Individuals Covered | 5250 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $108,920 | | Total amount of fees paid to insurance company | USD $95 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,194,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $108,920 | | Amount paid for insurance broker fees | 95 | | Additional information about fees paid to insurance broker | ADDL FEES - NON MONETARY COMPENSA- TION & MARKETING FEES | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10162241001 |
| Policy instance | 11 |
| Insurance contract or identification number | 10162241001 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of fees paid to insurance company | USD $3 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3 | | Additional information about fees paid to insurance broker | MGTF | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 132734 |
| Policy instance | 2 |
| Insurance contract or identification number | 132734 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $26,105 | | Welfare Benefit Premiums Paid to Carrier | USD $538,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 102775 |
| Policy instance | 3 |
| Insurance contract or identification number | 102775 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $798,797 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 658661 |
| Policy instance | 4 |
| Insurance contract or identification number | 658661 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $29,387 | | Welfare Benefit Premiums Paid to Carrier | USD $669,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 702698-EAP |
| Policy instance | 5 |
| Insurance contract or identification number | 702698-EAP | | Number of Individuals Covered | 11567 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $260,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012483-000 |
| Policy instance | 6 |
| Insurance contract or identification number | 16-012483-000 | | Number of Individuals Covered | 2691 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $60,687 | | Welfare Benefit Premiums Paid to Carrier | USD $1,213,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1500855 |
| Policy instance | 7 |
| Insurance contract or identification number | 1500855 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $5,646 | | Total amount of fees paid to insurance company | USD $49 | | Other welfare benefits provided | GROUP LEGAL PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $60,728 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V2820 |
| Policy instance | 8 |
| Insurance contract or identification number | V2820 | | Number of Individuals Covered | 628 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $64,055 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $281,933 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V3209 |
| Policy instance | 9 |
| Insurance contract or identification number | V3209 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $35,841 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $199,326 | | 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 number | 0157692 |
| Policy instance | 10 |
| Insurance contract or identification number | 0157692 | | Number of Individuals Covered | 5121 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $104,005 | | Total amount of fees paid to insurance company | USD $49 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,095,820 | | 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: 71870 ) |
| Policy contract number | 9750530 |
| Policy instance | 1 |
| Insurance contract or identification number | 9750530 | | Number of Individuals Covered | 4782 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $14,450 | | Total amount of fees paid to insurance company | USD $143 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $289,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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