401k Plan data: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. plan

KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 401k Plan overview

Plan Name	KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD.
Plan identification number	504

KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

HPC FOODS, LTD. has sponsored the creation of one or more 401k plans.

Company Name: HPC FOODS, LTD.

Employer identification number (EIN): 821607889

NAIC Classification: 311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2019-07-01
504 2019-01-01
504 2019-01-01
504 2018-01-01 MANIPHONE MALAVONG
504 2017-01-01 MANIPHONE MALAVONG

Plan Statistics for KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD.

401k plan membership statisitcs for KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD.

Measure Date Value
2019: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2019 401k membership
Total participants, beginning-of-year 2019-07-01 16
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 15
Total of all active and inactive participants 2019-07-01 15
Total participants 2019-07-01 15
Total participants, beginning-of-year 2019-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 16
Total of all active and inactive participants 2019-01-01 16
Total participants 2019-01-01 16
2018: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 16
Total of all active and inactive participants 2018-01-01 16
Total participants 2018-01-01 16
2017: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 13
Total of all active and inactive participants 2017-01-01 13
Total participants 2017-01-01 13

Measure	Date	Value
2019: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2019 401k membership
Total participants, beginning-of-year	2019-07-01	16
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	15
Total of all active and inactive participants	2019-07-01	15
Total participants	2019-07-01	15
Total participants, beginning-of-year	2019-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	16
Total of all active and inactive participants	2019-01-01	16
Total participants	2019-01-01	16
2018: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	16
Total of all active and inactive participants	2018-01-01	16
Total participants	2018-01-01	16
2017: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	13
Total of all active and inactive participants	2017-01-01	13
Total participants	2017-01-01	13

Form 5500 Responses for KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD.

2019: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: KAISER MEDICAL PLAN FOR THE EMPLOYEES OF HPC FOODS, LTD. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

321

Policy instance

Insurance contract or identification number	321
Number of Individuals Covered	15
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,340
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $95,320
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

321

Policy instance

Insurance contract or identification number	321
Number of Individuals Covered	16
Insurance policy start date	2019-01-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,385
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $48,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,673
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

321

Policy instance

Insurance contract or identification number	321
Number of Individuals Covered	16
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,158
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $88,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,158

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

321

Policy instance

Insurance contract or identification number	321
Number of Individuals Covered	16
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $90,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HPC FOODS, LTD.
Employer identification number (EIN):	821607889
NAIC Classification:	311900
NAIC Description:	Other Food Manufacturing