TOYS R US, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TOYS R US EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2017: TOYS R US EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 6,896 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 3,771 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 233 |
| Total of all active and inactive participants | 2017-07-01 | 4,004 |
| 2016: TOYS R US EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 7,127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 6,481 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 415 |
| Total of all active and inactive participants | 2016-07-01 | 6,896 |
| 2015: TOYS R US EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 7,502 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 7,051 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 76 |
| Total of all active and inactive participants | 2015-07-01 | 7,127 |
| 2014: TOYS R US EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 8,270 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 7,420 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 82 |
| Total of all active and inactive participants | 2014-07-01 | 7,502 |
| Total participants | 2014-07-01 | 0 |
| 2013: TOYS R US EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 8,683 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 8,157 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 113 |
| Total of all active and inactive participants | 2013-07-01 | 8,270 |
| Total participants | 2013-07-01 | 0 |
| 2012: TOYS R US EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 8,971 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 8,522 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 161 |
| Total of all active and inactive participants | 2012-07-01 | 8,683 |
| Total participants | 2012-07-01 | 0 |
| 2011: TOYS R US EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 9,370 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 8,863 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 108 |
| Total of all active and inactive participants | 2011-07-01 | 8,971 |
| Total participants | 2011-07-01 | 8,971 |
| 2010: TOYS R US EMPLOYEE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 10,394 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 9,178 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 192 |
| Total of all active and inactive participants | 2010-07-01 | 9,370 |
| Total participants | 2010-07-01 | 9,370 |
| 2009: TOYS R US EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 11,812 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 10,295 |
| Number of retired or separated participants receiving benefits | 2009-02-01 | 284 |
| Total of all active and inactive participants | 2009-02-01 | 10,579 |
| Total participants | 2009-02-01 | 10,579 |
| Measure | Date | Value |
|---|
| 2011 : TOYS R US EMPLOYEE BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-06-30 | $77,845,529 |
| Total of all expenses incurred | 2011-06-30 | $77,885,643 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $75,998,010 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $77,845,529 |
| Value of total assets at beginning of year | 2011-06-30 | $40,114 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $1,887,633 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Administrative expenses professional fees incurred | 2011-06-30 | $1,666,929 |
| Was this plan covered by a fidelity bond | 2011-06-30 | Yes |
| Value of fidelity bond cover | 2011-06-30 | $25,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $26,510,500 |
| Administrative expenses (other) incurred | 2011-06-30 | $102,037 |
| Total non interest bearing cash at beginning of year | 2011-06-30 | $40,114 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $-40,114 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $40,114 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $7,820,873 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $51,335,029 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-06-30 | $68,177,137 |
| Contract administrator fees | 2011-06-30 | $118,667 |
| Did the plan have assets held for investment | 2011-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | DELOITTE & TOUCHE LLP |
| Accountancy firm EIN | 2011-06-30 | 133891517 |
| 2010 : TOYS R US EMPLOYEE BENEFIT PLAN 2010 401k financial data |
|---|
| Total income from all sources (including contributions) | 2010-06-30 | $35,953,090 |
| Total of all expenses incurred | 2010-06-30 | $35,953,090 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-06-30 | $34,991,611 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-06-30 | $35,953,090 |
| Value of total assets at end of year | 2010-06-30 | $40,114 |
| Value of total assets at beginning of year | 2010-06-30 | $40,114 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-06-30 | $961,479 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-06-30 | No |
| Administrative expenses professional fees incurred | 2010-06-30 | $814,507 |
| Was this plan covered by a fidelity bond | 2010-06-30 | Yes |
| Value of fidelity bond cover | 2010-06-30 | $25,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-06-30 | No |
| Contributions received from participants | 2010-06-30 | $10,704,771 |
| Administrative expenses (other) incurred | 2010-06-30 | $58,806 |
| Total non interest bearing cash at end of year | 2010-06-30 | $40,114 |
| Total non interest bearing cash at beginning of year | 2010-06-30 | $40,114 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-06-30 | No |
| Value of net income/loss | 2010-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2010-06-30 | $40,114 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-06-30 | $40,114 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-06-30 | $3,287,411 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-06-30 | No |
| Contributions received in cash from employer | 2010-06-30 | $25,248,319 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-06-30 | $31,704,200 |
| Contract administrator fees | 2010-06-30 | $88,166 |
| Did the plan have assets held for investment | 2010-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-06-30 | Unqualified |
| Accountancy firm name | 2010-06-30 | DELOITTE & TOUCHE LLP |
| Accountancy firm EIN | 2010-06-30 | 133891517 |
| 2017: TOYS R US EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: TOYS R US EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: TOYS R US EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: TOYS R US EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: TOYS R US EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: TOYS R US EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: TOYS R US EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | Yes |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: TOYS R US EMPLOYEE BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan funding arrangement – Trust | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement - Trust | Yes |
| 2009: TOYS R US EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – Trust | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement - Trust | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231890 |
| Policy instance | 5 |
| Insurance contract or identification number | 231890 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,918,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004217 |
| Policy instance | 4 |
| Insurance contract or identification number | SP0004217 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 604356 |
| Policy instance | 3 |
| Insurance contract or identification number | 604356 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $938,638 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 2 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $217,130 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0721099-0820362 |
| Policy instance | 1 |
| Insurance contract or identification number | 0721099-0820362 | | Number of Individuals Covered | 904 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $394,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0721099-0820362 |
| Policy instance | 1 |
| Insurance contract or identification number | 0721099-0820362 | | Number of Individuals Covered | 1863 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $540,290 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 2 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $260,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 604356 |
| Policy instance | 3 |
| Insurance contract or identification number | 604356 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,256,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004217 |
| Policy instance | 4 |
| Insurance contract or identification number | SP0004217 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231890 |
| Policy instance | 5 |
| Insurance contract or identification number | 231890 | | Number of Individuals Covered | 602 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,263,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0721099-0820362 |
| Policy instance | 1 |
| Insurance contract or identification number | 0721099-0820362 | | Number of Individuals Covered | 2450 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $615,463 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 231890 |
| Policy instance | 2 |
| Insurance contract or identification number | 231890 | | Number of Individuals Covered | 660 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,227,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 3 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $206,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 604356 |
| Policy instance | 4 |
| Insurance contract or identification number | 604356 | | Number of Individuals Covered | 363 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,332,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004217 |
| Policy instance | 5 |
| Insurance contract or identification number | SP0004217 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0721099-0820362 |
| Policy instance | 1 |
| Insurance contract or identification number | 0721099-0820362 | | Number of Individuals Covered | 2452 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $698,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 225916 |
| Policy instance | 2 |
| Insurance contract or identification number | 225916 | | Number of Individuals Covered | 646 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $2,245,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 3 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $202,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600548 |
| Policy instance | 4 |
| Insurance contract or identification number | 600548 | | Number of Individuals Covered | 369 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $1,339,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004217 |
| Policy instance | 5 |
| Insurance contract or identification number | SP0004217 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004217 |
| Policy instance | 1 |
| Insurance contract or identification number | SP0004217 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600548 |
| Policy instance | 2 |
| Insurance contract or identification number | 600548 | | Number of Individuals Covered | 361 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $1,364,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 3 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $159,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 225916 |
| Policy instance | 4 |
| Insurance contract or identification number | 225916 | | Number of Individuals Covered | 636 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $1,984,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 721099-820362 |
| Policy instance | 5 |
| Insurance contract or identification number | 721099-820362 | | Number of Individuals Covered | 2512 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $682,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | 1-70781 |
| Policy instance | 1 |
| Insurance contract or identification number | 1-70781 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 225916 |
| Policy instance | 4 |
| Insurance contract or identification number | 225916 | | Number of Individuals Covered | 782 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $2,743,079 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600548 |
| Policy instance | 3 |
| Insurance contract or identification number | 600548 | | Number of Individuals Covered | 361 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $1,409,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 2 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $168,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 721099 |
| Policy instance | 5 |
| Insurance contract or identification number | 721099 | | Number of Individuals Covered | 2662 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $711,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 721099 |
| Policy instance | 5 |
| Insurance contract or identification number | 721099 | | Number of Individuals Covered | 2751 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $686,474 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600548 |
| Policy instance | 3 |
| Insurance contract or identification number | 600548 | | Number of Individuals Covered | 369 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $1,254,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 2 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $120,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | 1-70781 |
| Policy instance | 1 |
| Insurance contract or identification number | 1-70781 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 225916 |
| Policy instance | 4 |
| Insurance contract or identification number | 225916 | | Number of Individuals Covered | 741 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $2,361,908 | | 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: 0000 ) |
| Policy contract number | 600548 |
| Policy instance | 2 |
| Insurance contract or identification number | 600548 | | Number of Individuals Covered | 414 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2010-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $535,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 225916 |
| Policy instance | 5 |
| Insurance contract or identification number | 225916 | | Number of Individuals Covered | 758 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2010-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $929,381 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | 1-70781 |
| Policy instance | 4 |
| Insurance contract or identification number | 1-70781 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2010-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MAJOR MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 12280 |
| Policy instance | 3 |
| Insurance contract or identification number | 12280 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2010-06-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 721099 |
| Policy instance | 1 |
| Insurance contract or identification number | 721099 | | Number of Individuals Covered | 3124 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $784,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
