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NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameNORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

NORTH BAY BUILDERS EXCHANGES, INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTH BAY BUILDERS EXCHANGES, INC.
Employer identification number (EIN):454745482
NAIC Classification:524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-02-01
5012020-04-01
5012020-04-01
5012019-04-01
5012019-04-01
5012018-04-01
5012018-04-01
5012017-04-01KEITH WOODS
5012017-04-01
5012016-04-01KEITH WOODS
5012016-04-01
5012015-04-01
5012014-04-01
5012013-04-01

Plan Statistics for NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2021: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-011,111
Total number of active participants reported on line 7a of the Form 55002021-02-01919
Number of retired or separated participants receiving benefits2021-02-019
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01928
2020: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-011,129
Total number of active participants reported on line 7a of the Form 55002020-04-011,101
Number of retired or separated participants receiving benefits2020-04-0110
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-011,111
2019: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-011,181
Total number of active participants reported on line 7a of the Form 55002019-04-011,123
Number of retired or separated participants receiving benefits2019-04-016
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-011,129
2018: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01610
Total number of active participants reported on line 7a of the Form 55002018-04-011,172
Number of retired or separated participants receiving benefits2018-04-019
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-011,181
2017: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01708
Total number of active participants reported on line 7a of the Form 55002017-04-01610
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01610
2016: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-011,514
Total number of active participants reported on line 7a of the Form 55002016-04-011,500
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-011,500
2015: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-011,547
Total number of active participants reported on line 7a of the Form 55002015-04-011,514
Total of all active and inactive participants2015-04-011,514
Total participants2015-04-011,514
2014: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-011,654
Total number of active participants reported on line 7a of the Form 55002014-04-011,547
Total of all active and inactive participants2014-04-011,547
Total participants2014-04-011,547
2013: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-011,661
Total number of active participants reported on line 7a of the Form 55002013-04-011,654
Total of all active and inactive participants2013-04-011,654

Financial Data on NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-01-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-01-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-01-31$0
Total income from all sources (including contributions)2022-01-31$10,232,507
Total loss/gain on sale of assets2022-01-31$0
Total of all expenses incurred2022-01-31$10,840,417
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-01-31$10,060,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-01-31$10,232,507
Value of total assets at end of year2022-01-31$3,109,616
Value of total assets at beginning of year2022-01-31$3,717,526
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-01-31$779,501
Total interest from all sources2022-01-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-01-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-01-31No
Administrative expenses professional fees incurred2022-01-31$62,936
Was this plan covered by a fidelity bond2022-01-31Yes
Value of fidelity bond cover2022-01-31$250,000
If this is an individual account plan, was there a blackout period2022-01-31No
Were there any nonexempt tranactions with any party-in-interest2022-01-31No
Administrative expenses (other) incurred2022-01-31$486,242
Total non interest bearing cash at end of year2022-01-31$3,109,616
Total non interest bearing cash at beginning of year2022-01-31$3,717,526
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-01-31No
Value of net income/loss2022-01-31$-607,910
Value of net assets at end of year (total assets less liabilities)2022-01-31$3,109,616
Value of net assets at beginning of year (total assets less liabilities)2022-01-31$3,717,526
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-01-31No
Were any leases to which the plan was party in default or uncollectible2022-01-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-01-31$6,434,020
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-01-31No
Was there a failure to transmit to the plan any participant contributions2022-01-31No
Has the plan failed to provide any benefit when due under the plan2022-01-31No
Contributions received in cash from employer2022-01-31$10,232,507
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-01-31$3,626,896
Contract administrator fees2022-01-31$230,323
Did the plan have assets held for investment2022-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-01-31No
Opinion of an independent qualified public accountant for this plan2022-01-31Unqualified
Accountancy firm name2022-01-31MOSS ADAMS LLP
Accountancy firm EIN2022-01-31910189318
2021 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-01-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-01-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-01-31$0
Total income from all sources (including contributions)2021-01-31$0
Total loss/gain on sale of assets2021-01-31$0
Total of all expenses incurred2021-01-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-01-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-01-31$0
Value of total assets at end of year2021-01-31$2,482,485
Value of total assets at beginning of year2021-01-31$2,482,485
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-01-31$0
Total interest from all sources2021-01-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-01-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-01-31No
Administrative expenses professional fees incurred2021-01-31$2,678
Was this plan covered by a fidelity bond2021-01-31No
Value of fidelity bond cover2021-01-31$250,000
If this is an individual account plan, was there a blackout period2021-01-31No
Were there any nonexempt tranactions with any party-in-interest2021-01-31No
Participant contributions at end of year2021-01-31$0
Participant contributions at beginning of year2021-01-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-01-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-01-31$0
Administrative expenses (other) incurred2021-01-31$310,290
Total non interest bearing cash at end of year2021-01-31$2,482,485
Total non interest bearing cash at beginning of year2021-01-31$2,482,485
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-01-31No
Value of net income/loss2021-01-31$0
Value of net assets at end of year (total assets less liabilities)2021-01-31$2,482,485
Value of net assets at beginning of year (total assets less liabilities)2021-01-31$2,482,485
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-01-31No
Were any leases to which the plan was party in default or uncollectible2021-01-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-01-31$5,645,401
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-01-31No
Was there a failure to transmit to the plan any participant contributions2021-01-31No
Has the plan failed to provide any benefit when due under the plan2021-01-31No
Contributions received in cash from employer2021-01-31$9,249,786
Employer contributions (assets) at end of year2021-01-31$0
Employer contributions (assets) at beginning of year2021-01-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-01-31$2,765,910
Contract administrator fees2021-01-31$196,999
Did the plan have assets held for investment2021-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-01-31No
Opinion of an independent qualified public accountant for this plan2021-01-31Unqualified
Accountancy firm name2021-01-31MOSS ADAMS LLP
Accountancy firm EIN2021-01-31910189318
2020 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total income from all sources (including contributions)2020-03-31$0
Total loss/gain on sale of assets2020-03-31$0
Total of all expenses incurred2020-03-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-03-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-03-31$0
Value of total assets at end of year2020-03-31$2,482,485
Value of total assets at beginning of year2020-03-31$2,482,485
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-03-31$0
Total interest from all sources2020-03-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Administrative expenses professional fees incurred2020-03-31$2,470
Was this plan covered by a fidelity bond2020-03-31No
Value of fidelity bond cover2020-03-31$250,000
If this is an individual account plan, was there a blackout period2020-03-31No
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Participant contributions at beginning of year2020-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-03-31$0
Other income not declared elsewhere2020-03-31$2,944
Administrative expenses (other) incurred2020-03-31$372,918
Total non interest bearing cash at end of year2020-03-31$2,482,485
Total non interest bearing cash at beginning of year2020-03-31$2,482,485
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Value of net income/loss2020-03-31$0
Value of net assets at end of year (total assets less liabilities)2020-03-31$2,482,485
Value of net assets at beginning of year (total assets less liabilities)2020-03-31$2,482,485
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-03-31$6,543,677
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31No
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Contributions received in cash from employer2020-03-31$10,987,914
Employer contributions (assets) at beginning of year2020-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-03-31$2,975,967
Contract administrator fees2020-03-31$189,292
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-03-31No
Liabilities. Value of benefit claims payable at beginning of year2020-03-31$0
Did the plan have assets held for investment2020-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-03-31No
Opinion of an independent qualified public accountant for this plan2020-03-31Unqualified
Accountancy firm name2020-03-31MOSS ADAMS LLP
Accountancy firm EIN2020-03-31910189318
2019 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-03-31$0
Total income from all sources (including contributions)2019-03-31$10,635,126
Total loss/gain on sale of assets2019-03-31$0
Total of all expenses incurred2019-03-31$10,000,716
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-03-31$9,427,839
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-03-31$10,632,727
Value of total assets at end of year2019-03-31$2,482,484
Value of total assets at beginning of year2019-03-31$1,848,074
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-03-31$572,877
Total interest from all sources2019-03-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-03-31No
Administrative expenses professional fees incurred2019-03-31$14,446
Was this plan covered by a fidelity bond2019-03-31Yes
Value of fidelity bond cover2019-03-31$250,000
If this is an individual account plan, was there a blackout period2019-03-31No
Were there any nonexempt tranactions with any party-in-interest2019-03-31No
Participant contributions at end of year2019-03-31$0
Participant contributions at beginning of year2019-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-03-31$2,395
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-03-31$0
Other income not declared elsewhere2019-03-31$2,399
Administrative expenses (other) incurred2019-03-31$374,081
Total non interest bearing cash at end of year2019-03-31$2,482,484
Total non interest bearing cash at beginning of year2019-03-31$1,848,074
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-03-31No
Value of net income/loss2019-03-31$634,410
Value of net assets at end of year (total assets less liabilities)2019-03-31$2,482,484
Value of net assets at beginning of year (total assets less liabilities)2019-03-31$1,848,074
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-03-31No
Were any leases to which the plan was party in default or uncollectible2019-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-03-31$5,984,661
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-03-31No
Was there a failure to transmit to the plan any participant contributions2019-03-31No
Has the plan failed to provide any benefit when due under the plan2019-03-31No
Contributions received in cash from employer2019-03-31$10,632,727
Employer contributions (assets) at end of year2019-03-31$0
Employer contributions (assets) at beginning of year2019-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-03-31$3,443,178
Contract administrator fees2019-03-31$184,350
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-03-31No
Liabilities. Value of benefit claims payable at end of year2019-03-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-03-31$0
Did the plan have assets held for investment2019-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-03-31No
Opinion of an independent qualified public accountant for this plan2019-03-31Unqualified
Accountancy firm name2019-03-31MOSS ADAMS LLP
Accountancy firm EIN2019-03-31910189318
2018 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-03-31$1,059,493
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-03-31$883,134
Total income from all sources (including contributions)2018-03-31$11,496,033
Total loss/gain on sale of assets2018-03-31$0
Total of all expenses incurred2018-03-31$11,775,144
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-03-31$11,228,046
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-03-31$11,496,033
Value of total assets at end of year2018-03-31$1,220,512
Value of total assets at beginning of year2018-03-31$1,323,264
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-03-31$547,098
Total interest from all sources2018-03-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-03-31No
Administrative expenses professional fees incurred2018-03-31$28,844
Was this plan covered by a fidelity bond2018-03-31No
Value of fidelity bond cover2018-03-31$250,000
If this is an individual account plan, was there a blackout period2018-03-31No
Were there any nonexempt tranactions with any party-in-interest2018-03-31No
Participant contributions at end of year2018-03-31$0
Participant contributions at beginning of year2018-03-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-03-31$1,141,043
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-03-31$623,682
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-03-31$1,030,993
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-03-31$842,518
Other income not declared elsewhere2018-03-31$3,181
Administrative expenses (other) incurred2018-03-31$388,518
Liabilities. Value of operating payables at end of year2018-03-31$0
Liabilities. Value of operating payables at beginning of year2018-03-31$3,217
Total non interest bearing cash at end of year2018-03-31$0
Total non interest bearing cash at beginning of year2018-03-31$606,088
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-03-31No
Value of net income/loss2018-03-31$-279,111
Value of net assets at end of year (total assets less liabilities)2018-03-31$161,019
Value of net assets at beginning of year (total assets less liabilities)2018-03-31$440,130
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-03-31No
Were any leases to which the plan was party in default or uncollectible2018-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-03-31$10,585,558
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-03-31No
Was there a failure to transmit to the plan any participant contributions2018-03-31No
Has the plan failed to provide any benefit when due under the plan2018-03-31No
Contributions received in cash from employer2018-03-31$11,496,033
Employer contributions (assets) at end of year2018-03-31$79,469
Employer contributions (assets) at beginning of year2018-03-31$93,494
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-03-31$642,488
Contract administrator fees2018-03-31$518,254
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-03-31No
Liabilities. Value of benefit claims payable at end of year2018-03-31$28,500
Liabilities. Value of benefit claims payable at beginning of year2018-03-31$37,399
Did the plan have assets held for investment2018-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-03-31No
Opinion of an independent qualified public accountant for this plan2018-03-31Unqualified
Accountancy firm name2018-03-31PISENTI & BRINKER LLP
Accountancy firm EIN2018-03-31941585562
2017 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-03-31$1,059,493
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-03-31$883,134
Expenses. Interest paid2017-03-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022017-03-31$0
Total income from all sources (including contributions)2017-03-31$11,496,033
Total loss/gain on sale of assets2017-03-31$0
Total of all expenses incurred2017-03-31$11,775,144
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-03-31$11,228,046
Expenses. Certain deemed distributions of participant loans2017-03-31$0
Value of total corrective distributions2017-03-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-03-31$11,496,033
Value of total assets at end of year2017-03-31$1,220,512
Value of total assets at beginning of year2017-03-31$1,323,264
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-03-31$547,098
Total interest from all sources2017-03-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-03-31No
Administrative expenses professional fees incurred2017-03-31$28,844
Was this plan covered by a fidelity bond2017-03-31No
If this is an individual account plan, was there a blackout period2017-03-31No
Were there any nonexempt tranactions with any party-in-interest2017-03-31No
Contributions received from participants2017-03-31$0
Participant contributions at end of year2017-03-31$0
Participant contributions at beginning of year2017-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-03-31$1,141,043
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-03-31$623,682
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-03-31$1,030,993
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-03-31$842,518
Other income not declared elsewhere2017-03-31$4,636
Administrative expenses (other) incurred2017-03-31$6,433
Liabilities. Value of operating payables at end of year2017-03-31$0
Liabilities. Value of operating payables at beginning of year2017-03-31$3,217
Total non interest bearing cash at end of year2017-03-31$0
Total non interest bearing cash at beginning of year2017-03-31$606,088
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-03-31No
Income. Non cash contributions2017-03-31$0
Value of net income/loss2017-03-31$-279,111
Value of net assets at end of year (total assets less liabilities)2017-03-31$161,019
Value of net assets at beginning of year (total assets less liabilities)2017-03-31$440,130
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-03-31No
Were any leases to which the plan was party in default or uncollectible2017-03-31No
Interest on participant loans2017-03-31$0
Income. Interest from loans (other than to participants)2017-03-31$0
Income. Interest from US Government securities2017-03-31$0
Income. Interest from corporate debt instruments2017-03-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-03-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2017-03-31$10,585,558
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-03-31No
Was there a failure to transmit to the plan any participant contributions2017-03-31No
Has the plan failed to provide any benefit when due under the plan2017-03-31No
Contributions received in cash from employer2017-03-31$11,496,033
Employer contributions (assets) at end of year2017-03-31$79,469
Employer contributions (assets) at beginning of year2017-03-31$93,494
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-03-31$642,488
Contract administrator fees2017-03-31$518,254
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-03-31No
Liabilities. Value of benefit claims payable at end of year2017-03-31$28,500
Liabilities. Value of benefit claims payable at beginning of year2017-03-31$37,399
Did the plan have assets held for investment2017-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-03-31No
Liabilities. Value of acquisition indebtedness at end of year2017-03-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2017-03-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-03-31No
Opinion of an independent qualified public accountant for this plan2017-03-31Unqualified
Accountancy firm name2017-03-31PISENTI & BRINKER LLP
Accountancy firm EIN2017-03-31941585562
2016 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-03-31$883,134
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-03-31$843,474
Total income from all sources (including contributions)2016-03-31$10,648,867
Total loss/gain on sale of assets2016-03-31$0
Total of all expenses incurred2016-03-31$10,761,749
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-03-31$10,188,405
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-03-31$10,648,718
Value of total assets at end of year2016-03-31$1,323,264
Value of total assets at beginning of year2016-03-31$1,396,486
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-03-31$573,344
Total interest from all sources2016-03-31$149
Total dividends received (eg from common stock, registered investment company shares)2016-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-03-31No
Administrative expenses professional fees incurred2016-03-31$23,613
Was this plan covered by a fidelity bond2016-03-31No
If this is an individual account plan, was there a blackout period2016-03-31No
Were there any nonexempt tranactions with any party-in-interest2016-03-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-03-31$623,682
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-03-31$918,462
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-03-31$842,518
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-03-31$779,180
Liabilities. Value of operating payables at end of year2016-03-31$3,217
Liabilities. Value of operating payables at beginning of year2016-03-31$12,098
Total non interest bearing cash at end of year2016-03-31$606,088
Total non interest bearing cash at beginning of year2016-03-31$424,290
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-03-31No
Value of net income/loss2016-03-31$-112,882
Value of net assets at end of year (total assets less liabilities)2016-03-31$440,130
Value of net assets at beginning of year (total assets less liabilities)2016-03-31$553,012
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-03-31No
Were any leases to which the plan was party in default or uncollectible2016-03-31No
Interest earned on other investments2016-03-31$149
Expenses. Payments to insurance carriers foe the provision of benefits2016-03-31$9,598,372
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-03-31No
Was there a failure to transmit to the plan any participant contributions2016-03-31No
Has the plan failed to provide any benefit when due under the plan2016-03-31No
Contributions received in cash from employer2016-03-31$10,648,718
Employer contributions (assets) at end of year2016-03-31$93,494
Employer contributions (assets) at beginning of year2016-03-31$53,734
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-03-31$590,033
Contract administrator fees2016-03-31$549,731
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-03-31No
Liabilities. Value of benefit claims payable at end of year2016-03-31$37,399
Liabilities. Value of benefit claims payable at beginning of year2016-03-31$52,196
Did the plan have assets held for investment2016-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-03-31No
Opinion of an independent qualified public accountant for this plan2016-03-31Unqualified
Accountancy firm name2016-03-31PISENTI & BRINKER LLP
Accountancy firm EIN2016-03-31941585562
2015 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-03-31$843,474
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-03-31$785,001
Total income from all sources (including contributions)2015-03-31$10,392,921
Total loss/gain on sale of assets2015-03-31$0
Total of all expenses incurred2015-03-31$10,465,198
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-03-31$9,816,042
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-03-31$10,392,630
Value of total assets at end of year2015-03-31$1,396,486
Value of total assets at beginning of year2015-03-31$1,410,290
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-03-31$649,156
Total interest from all sources2015-03-31$291
Total dividends received (eg from common stock, registered investment company shares)2015-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-03-31No
Administrative expenses professional fees incurred2015-03-31$16,884
Was this plan covered by a fidelity bond2015-03-31No
If this is an individual account plan, was there a blackout period2015-03-31No
Were there any nonexempt tranactions with any party-in-interest2015-03-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-03-31$918,462
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-03-31$187,388
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-03-31$779,180
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-03-31$735,323
Administrative expenses (other) incurred2015-03-31$292,190
Liabilities. Value of operating payables at end of year2015-03-31$12,098
Liabilities. Value of operating payables at beginning of year2015-03-31$49,678
Total non interest bearing cash at end of year2015-03-31$424,290
Total non interest bearing cash at beginning of year2015-03-31$1,120,246
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-03-31No
Value of net income/loss2015-03-31$-72,277
Value of net assets at end of year (total assets less liabilities)2015-03-31$553,012
Value of net assets at beginning of year (total assets less liabilities)2015-03-31$625,289
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-03-31No
Were any leases to which the plan was party in default or uncollectible2015-03-31No
Interest earned on other investments2015-03-31$291
Expenses. Payments to insurance carriers foe the provision of benefits2015-03-31$9,116,381
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-03-31No
Was there a failure to transmit to the plan any participant contributions2015-03-31No
Has the plan failed to provide any benefit when due under the plan2015-03-31No
Contributions received in cash from employer2015-03-31$10,392,630
Employer contributions (assets) at end of year2015-03-31$53,734
Employer contributions (assets) at beginning of year2015-03-31$102,656
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-03-31$699,661
Contract administrator fees2015-03-31$340,082
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-03-31No
Liabilities. Value of benefit claims payable at end of year2015-03-31$52,196
Liabilities. Value of benefit claims payable at beginning of year2015-03-31$0
Did the plan have assets held for investment2015-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-03-31No
Opinion of an independent qualified public accountant for this plan2015-03-31Unqualified
Accountancy firm name2015-03-31PISENTI & BRINKER LLP
Accountancy firm EIN2015-03-31941585562
2014 : NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-03-31$785,001
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-03-31$694,409
Total income from all sources (including contributions)2014-03-31$0
Total of all expenses incurred2014-03-31$11,636,624
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-03-31$10,815,998
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-03-31$11,640,497
Value of total assets at end of year2014-03-31$1,410,290
Value of total assets at beginning of year2014-03-31$1,315,825
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-03-31$820,626
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-03-31No
Was this plan covered by a fidelity bond2014-03-31No
If this is an individual account plan, was there a blackout period2014-03-31No
Were there any nonexempt tranactions with any party-in-interest2014-03-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-03-31$187,388
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-03-31$676,469
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-03-31$735,323
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-03-31$694,262
Administrative expenses (other) incurred2014-03-31$492,923
Liabilities. Value of operating payables at end of year2014-03-31$49,678
Liabilities. Value of operating payables at beginning of year2014-03-31$147
Total non interest bearing cash at end of year2014-03-31$1,120,246
Total non interest bearing cash at beginning of year2014-03-31$495,306
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-03-31No
Value of net income/loss2014-03-31$3,873
Value of net assets at end of year (total assets less liabilities)2014-03-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-03-31$621,416
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-03-31No
Were any leases to which the plan was party in default or uncollectible2014-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-03-31$10,815,998
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-03-31No
Was there a failure to transmit to the plan any participant contributions2014-03-31No
Has the plan failed to provide any benefit when due under the plan2014-03-31No
Contributions received in cash from employer2014-03-31$11,640,497
Employer contributions (assets) at end of year2014-03-31$102,656
Employer contributions (assets) at beginning of year2014-03-31$144,050
Contract administrator fees2014-03-31$327,703
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-03-31No
Did the plan have assets held for investment2014-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-03-31No
Opinion of an independent qualified public accountant for this plan2014-03-31Unqualified
Accountancy firm name2014-03-31MAHER ACCOUNTANCY
Accountancy firm EIN2014-03-31273019797

Form 5500 Responses for NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN

2021: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-02-01Type of plan entityMulitple employer plan
2021-02-01Submission has been amendedYes
2021-02-01This submission is the final filingNo
2021-02-01This return/report is a short plan year return/report (less than 12 months)No
2021-02-01Plan is a collectively bargained planNo
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan funding arrangement – TrustYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement - TrustYes
2020: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-04-01Type of plan entityMulitple employer plan
2020-04-01Submission has been amendedYes
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – TrustYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement - TrustYes
2019: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-04-01Type of plan entityMulitple employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – TrustYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement - TrustYes
2018: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-04-01Type of plan entityMulitple employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – TrustYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement - TrustYes
2017: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-04-01Type of plan entityMulitple employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement - TrustYes
2016: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-04-01Type of plan entityMulitple employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement - TrustYes
2015: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-04-01Type of plan entityMulitple employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – TrustYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement - TrustYes
2014: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-04-01Type of plan entityMulitple employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – TrustYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement - TrustYes
2013: NORTH BAY BUILDERS EXCHANGES, INC. HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-04-01Type of plan entityMulitple employer plan
2013-04-01Submission has been amendedYes
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – TrustYes
2013-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 4
Insurance contract or identification number603780
Number of Individuals Covered730
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $356,753
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,760,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $356,753
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 3
Insurance contract or identification number12335317
Number of Individuals Covered199
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $891
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $17,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $891
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231224
Policy instance 2
Insurance contract or identification number231224
Number of Individuals Covered0
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 1
Insurance contract or identification number170225
Number of Individuals Covered133
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $999
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $999
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 5
Insurance contract or identification number277158
Number of Individuals Covered201
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $13,135
Total amount of fees paid to insurance companyUSD $145
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $35,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,135
Amount paid for insurance broker fees145
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 4
Insurance contract or identification number603780
Number of Individuals Covered920
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $408,298
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,626,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $408,298
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231224
Policy instance 2
Insurance contract or identification number231224
Number of Individuals Covered1
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $-93
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,407
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 3
Insurance contract or identification number12335317
Number of Individuals Covered225
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $1,240
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $24,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,240
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 5
Insurance contract or identification number277158
Number of Individuals Covered254
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $153,474
Total amount of fees paid to insurance companyUSD $58,494
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $473,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $153,662
Amount paid for insurance broker fees907
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 1
Insurance contract or identification number170225
Number of Individuals Covered164
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $998
Total amount of fees paid to insurance companyUSD $89
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $998
Amount paid for insurance broker fees89
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 1
Insurance contract or identification number603780
Number of Individuals Covered920
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $408,298
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,626,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $408,298
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 2
Insurance contract or identification number170225
Number of Individuals Covered164
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $998
Total amount of fees paid to insurance companyUSD $89
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $998
Amount paid for insurance broker fees89
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 4
Insurance contract or identification number277158
Number of Individuals Covered254
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $153,474
Total amount of fees paid to insurance companyUSD $58,494
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $473,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $153,662
Amount paid for insurance broker fees907
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231224
Policy instance 5
Insurance contract or identification number231224
Number of Individuals Covered1
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $-93
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,407
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 3
Insurance contract or identification number277158
Number of Individuals Covered279
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $152,883
Total amount of fees paid to insurance companyUSD $555
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $394,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $140,052
Insurance broker organization code?3
Amount paid for insurance broker fees555
Additional information about fees paid to insurance brokerOTHER FEES
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 4
Insurance contract or identification number170225
Number of Individuals Covered166
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $537
Total amount of fees paid to insurance companyUSD $111
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $489
Insurance broker organization code?3
Amount paid for insurance broker fees111
Additional information about fees paid to insurance brokerOTHER FEES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231224
Policy instance 5
Insurance contract or identification number231224
Number of Individuals Covered1
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $232
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $232
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 2
Insurance contract or identification number12335317
Number of Individuals Covered267
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $1,153
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $23,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,153
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 1
Insurance contract or identification number170225
Number of Individuals Covered166
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $537
Total amount of fees paid to insurance companyUSD $111
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,795
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 number603780
Policy instance 1
Insurance contract or identification number603780
Number of Individuals Covered1035
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $360,137
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,523,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $360,137
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 5
Insurance contract or identification number603780
Number of Individuals Covered1035
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $360,137
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,523,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 4
Insurance contract or identification number277158
Number of Individuals Covered279
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $152,883
Total amount of fees paid to insurance companyUSD $555
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $394,728
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 number231224
Policy instance 3
Insurance contract or identification number231224
Number of Individuals Covered1
Insurance policy start date2020-04-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $232
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 1
Insurance contract or identification number12335317
Number of Individuals Covered263
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,259
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $26,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,259
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 3
Insurance contract or identification number277158
Number of Individuals Covered263
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $214,179
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $319,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $214,179
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 4
Insurance contract or identification number603780
Number of Individuals Covered1023
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $418,347
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,241,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $418,347
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 5
Insurance contract or identification number170225
Number of Individuals Covered168
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $604
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $604
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231224
Policy instance 2
Insurance contract or identification number231224
Number of Individuals Covered1
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $247
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $202
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 1
Insurance contract or identification number603780
Number of Individuals Covered1009
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $380,868
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,601,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $380,877
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 3
Insurance contract or identification number277158
Number of Individuals Covered266
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $131,701
Total amount of fees paid to insurance companyUSD $1,422
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $322,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $131,701
Amount paid for insurance broker fees1422
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 2
Insurance contract or identification number12335317
Number of Individuals Covered232
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,118
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $22,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $928
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number277158
Policy instance 1
Insurance contract or identification number277158
Number of Individuals Covered750
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $5,611
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $97,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,060
Insurance broker organization code?3
Insurance broker nameCRYSTAL IBC, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 1
Insurance contract or identification number12335317
Number of Individuals Covered272
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $1,382
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $27,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $915
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number277158
Policy instance 3
Insurance contract or identification number277158
Number of Individuals Covered750
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $5,611
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $97,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,060
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 2
Insurance contract or identification number603780
Number of Individuals Covered1080
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $634,984
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,856,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $412,762
Insurance broker organization code?3
Insurance broker nameCRYSTAL & COMPANY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 3
Insurance contract or identification number12335317
Number of Individuals Covered272
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $1,382
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $27,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $915
Insurance broker organization code?3
Insurance broker nameCRAFORD & CRAFORD
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number231224
Policy instance 4
Insurance contract or identification number231224
Number of Individuals Covered2
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $12,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 2
Insurance contract or identification number12335317
Number of Individuals Covered274
Insurance policy start date2016-04-01
Insurance policy end date2017-03-31
Total amount of commissions paid to insurance brokerUSD $1,545
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $30,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,545
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 1
Insurance contract or identification number603780
Number of Individuals Covered1064
Insurance policy start date2016-04-01
Insurance policy end date2017-03-31
Total amount of commissions paid to insurance brokerUSD $343,434
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,752,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $343,434
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number277158
Policy instance 3
Insurance contract or identification number277158
Number of Individuals Covered354
Insurance policy start date2016-04-01
Insurance policy end date2017-03-31
Total amount of commissions paid to insurance brokerUSD $234,926
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $234,926
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number277158
Policy instance 1
Insurance contract or identification number277158
Number of Individuals Covered350
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $185,941
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $185,941
Insurance broker nameCRAFORD & CRAFORD
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 2
Insurance contract or identification number277158
Number of Individuals Covered341
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $5,058
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $50,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,058
Insurance broker nameCRAFORD & CRAFORD
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 3
Insurance contract or identification number170225
Number of Individuals Covered346
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $1,250
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $28,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,250
Insurance broker nameCRAFORD & CRAFORD
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 4
Insurance contract or identification number603780
Number of Individuals Covered1096
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $342,543
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,329,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $342,543
Insurance broker nameCRAFORD & CRAFORD
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 5
Insurance contract or identification number12335317
Number of Individuals Covered292
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $1,425
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,425
Insurance broker organization code?3
Insurance broker nameCRAFORD & CRAFORD
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number277158
Policy instance 1
Insurance contract or identification number277158
Number of Individuals Covered298
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $191,606
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $191,606
Insurance broker nameCRAFORD & CRAFORD
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number277158
Policy instance 2
Insurance contract or identification number277158
Number of Individuals Covered363
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $6,243
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $50,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,243
Insurance broker nameCRAFORD & CRAFORD
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 3
Insurance contract or identification number170225
Number of Individuals Covered361
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $1,322
Total amount of fees paid to insurance companyUSD $115
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $24,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,322
Amount paid for insurance broker fees115
Insurance broker organization code?3
Insurance broker nameCRAFORD & CRAFORD
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 4
Insurance contract or identification number603780
Number of Individuals Covered1038
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $346,329
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,068,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $346,329
Insurance broker nameCRAFORD & CRAFORD
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 5
Insurance contract or identification number12335317
Number of Individuals Covered279
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $1,359
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,359
Insurance broker nameCRAFORD & CRAFORD
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12335317
Policy instance 5
Insurance contract or identification number12335317
Number of Individuals Covered276
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $1,376
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Commission paid to Insurance BrokerUSD $1,376
Insurance broker nameCRAFORD & CRAFORD
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170225
Policy instance 4
Insurance contract or identification number170225
Number of Individuals Covered770
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $1,446
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Commission paid to Insurance BrokerUSD $1,446
Insurance broker nameCRAFORD & CRAFORD
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number056412
Policy instance 3
Insurance contract or identification number056412
Number of Individuals Covered908
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $44,982
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $899,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Commission paid to Insurance BrokerUSD $44,982
Insurance broker nameCRAFORD & CRAFORD
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number277158
Policy instance 2
Insurance contract or identification number277158
Number of Individuals Covered330
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $188,644
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Commission paid to Insurance BrokerUSD $188,644
Insurance broker nameCRAFORD & CRAFORD
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number603780
Policy instance 1
Insurance contract or identification number603780
Number of Individuals Covered1097
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $286,166
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,694,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Commission paid to Insurance BrokerUSD $286,166
Insurance broker nameCRAFORD & CRAFORD

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