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FOLSOM LAKE FORD GROUP WELFARE PLAN 401k Plan overview

Plan NameFOLSOM LAKE FORD GROUP WELFARE PLAN
Plan identification number 507

FOLSOM LAKE FORD GROUP WELFARE PLAN Benefits

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

401k Sponsoring company profile

FOLSOM LAKE FORD has sponsored the creation of one or more 401k plans.

Company Name:FOLSOM LAKE FORD
Employer identification number (EIN):680168504
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOLSOM LAKE FORD GROUP WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072023-03-01JOHN SEARS2024-08-29
5072022-03-01JOHN SEARS2023-06-12
5072021-03-01JOHN SEARS2022-08-25
5072020-03-01JOHN SEARS2021-08-31
5072019-03-01JOHN SEARS2020-09-10
5072017-03-01
5072016-03-01JOHN SEARS JOHN SEARS2017-09-19
5072015-03-01JOHN SEARS
5072014-03-01JOHN SEARS
5072013-03-01JOHN SEARS
5072012-03-01JOHN SEARS
5072011-03-01JOHNSEARS JOHNSEARS2012-12-17
5072010-03-01JOHNSEARS JOHNSEARS2012-12-17
5072009-03-01JOHNSEARS JOHNSEARS2012-12-17
5072008-03-01JOHNSEARS JOHNSEARS2012-12-17
5072007-07-01JOHNSEARS JOHNSEARS2012-12-17
5072006-07-01JOHNSEARS JOHNSEARS2012-12-17
5072005-07-01JOHNSEARS JOHNSEARS2012-12-17
5072004-07-01JOHNSEARS JOHNSEARS2012-12-17
5072003-07-01JOHNSEARS JOHNSEARS2012-12-17
5072002-07-01JOHNSEARS JOHNSEARS2012-12-17
5072001-07-01JOHNSEARS JOHNSEARS2012-12-17
5072000-07-01JOHNSEARS JOHNSEARS2012-12-17

Plan Statistics for FOLSOM LAKE FORD GROUP WELFARE PLAN

401k plan membership statisitcs for FOLSOM LAKE FORD GROUP WELFARE PLAN

Measure Date Value
2023: FOLSOM LAKE FORD GROUP WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-03-01242
Total number of active participants reported on line 7a of the Form 55002023-03-01242
Number of retired or separated participants receiving benefits2023-03-010
Number of other retired or separated participants entitled to future benefits2023-03-010
Total of all active and inactive participants2023-03-01242
Number of employers contributing to the scheme2023-03-010
2022: FOLSOM LAKE FORD GROUP WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-03-01155
Total number of active participants reported on line 7a of the Form 55002022-03-01242
Number of retired or separated participants receiving benefits2022-03-010
Number of other retired or separated participants entitled to future benefits2022-03-010
Total of all active and inactive participants2022-03-01242
Number of employers contributing to the scheme2022-03-010
2021: FOLSOM LAKE FORD GROUP WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-01150
Total number of active participants reported on line 7a of the Form 55002021-03-01155
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-010
Total of all active and inactive participants2021-03-01155
Number of employers contributing to the scheme2021-03-010
2020: FOLSOM LAKE FORD GROUP WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-01150
Total number of active participants reported on line 7a of the Form 55002020-03-01150
Number of retired or separated participants receiving benefits2020-03-015
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-01155
Number of employers contributing to the scheme2020-03-010
2019: FOLSOM LAKE FORD GROUP WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01150
Total number of active participants reported on line 7a of the Form 55002019-03-01150
Number of retired or separated participants receiving benefits2019-03-015
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01155
Number of employers contributing to the scheme2019-03-010
2017: FOLSOM LAKE FORD GROUP WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01223
Total number of active participants reported on line 7a of the Form 55002017-03-01214
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01214
2016: FOLSOM LAKE FORD GROUP WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-01210
Total number of active participants reported on line 7a of the Form 55002016-03-01219
Number of retired or separated participants receiving benefits2016-03-014
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-01223
2015: FOLSOM LAKE FORD GROUP WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-01191
Total number of active participants reported on line 7a of the Form 55002015-03-01209
Number of retired or separated participants receiving benefits2015-03-011
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-01210
2014: FOLSOM LAKE FORD GROUP WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-01186
Total number of active participants reported on line 7a of the Form 55002014-03-01191
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01191
2013: FOLSOM LAKE FORD GROUP WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01169
Total number of active participants reported on line 7a of the Form 55002013-03-01180
Number of retired or separated participants receiving benefits2013-03-016
Number of other retired or separated participants entitled to future benefits2013-03-010
Total of all active and inactive participants2013-03-01186
2012: FOLSOM LAKE FORD GROUP WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01168
Total number of active participants reported on line 7a of the Form 55002012-03-01161
Number of retired or separated participants receiving benefits2012-03-018
Number of other retired or separated participants entitled to future benefits2012-03-010
Total of all active and inactive participants2012-03-01169
2011: FOLSOM LAKE FORD GROUP WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-01161
Total number of active participants reported on line 7a of the Form 55002011-03-01164
Number of retired or separated participants receiving benefits2011-03-014
Number of other retired or separated participants entitled to future benefits2011-03-010
Total of all active and inactive participants2011-03-01168
2010: FOLSOM LAKE FORD GROUP WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-01153
Total number of active participants reported on line 7a of the Form 55002010-03-01154
Number of retired or separated participants receiving benefits2010-03-017
Number of other retired or separated participants entitled to future benefits2010-03-010
Total of all active and inactive participants2010-03-01161
2009: FOLSOM LAKE FORD GROUP WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-01158
Total number of active participants reported on line 7a of the Form 55002009-03-01148
Number of retired or separated participants receiving benefits2009-03-015
Number of other retired or separated participants entitled to future benefits2009-03-010
Total of all active and inactive participants2009-03-01153
2008: FOLSOM LAKE FORD GROUP WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-03-01160
Total number of active participants reported on line 7a of the Form 55002008-03-01151
Number of retired or separated participants receiving benefits2008-03-017
Number of other retired or separated participants entitled to future benefits2008-03-010
Total of all active and inactive participants2008-03-01158
2007: FOLSOM LAKE FORD GROUP WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-07-01131
Total number of active participants reported on line 7a of the Form 55002007-07-01131
Number of retired or separated participants receiving benefits2007-07-010
Number of other retired or separated participants entitled to future benefits2007-07-010
Total of all active and inactive participants2007-07-01131
2006: FOLSOM LAKE FORD GROUP WELFARE PLAN 2006 401k membership
Total participants, beginning-of-year2006-07-01131
Total number of active participants reported on line 7a of the Form 55002006-07-01131
Number of retired or separated participants receiving benefits2006-07-010
Number of other retired or separated participants entitled to future benefits2006-07-010
Total of all active and inactive participants2006-07-01131
2005: FOLSOM LAKE FORD GROUP WELFARE PLAN 2005 401k membership
Total participants, beginning-of-year2005-07-01131
Total number of active participants reported on line 7a of the Form 55002005-07-01131
Number of retired or separated participants receiving benefits2005-07-010
Number of other retired or separated participants entitled to future benefits2005-07-010
Total of all active and inactive participants2005-07-01131
2004: FOLSOM LAKE FORD GROUP WELFARE PLAN 2004 401k membership
Total participants, beginning-of-year2004-07-01131
Total number of active participants reported on line 7a of the Form 55002004-07-01131
Number of retired or separated participants receiving benefits2004-07-010
Number of other retired or separated participants entitled to future benefits2004-07-010
Total of all active and inactive participants2004-07-01131
2003: FOLSOM LAKE FORD GROUP WELFARE PLAN 2003 401k membership
Total participants, beginning-of-year2003-07-01131
Total number of active participants reported on line 7a of the Form 55002003-07-01131
Number of retired or separated participants receiving benefits2003-07-010
Number of other retired or separated participants entitled to future benefits2003-07-010
Total of all active and inactive participants2003-07-01131
2002: FOLSOM LAKE FORD GROUP WELFARE PLAN 2002 401k membership
Total participants, beginning-of-year2002-07-01334
Total number of active participants reported on line 7a of the Form 55002002-07-01131
Number of retired or separated participants receiving benefits2002-07-010
Number of other retired or separated participants entitled to future benefits2002-07-010
Total of all active and inactive participants2002-07-01131
2001: FOLSOM LAKE FORD GROUP WELFARE PLAN 2001 401k membership
Total participants, beginning-of-year2001-07-01334
Total number of active participants reported on line 7a of the Form 55002001-07-01334
Number of retired or separated participants receiving benefits2001-07-010
Number of other retired or separated participants entitled to future benefits2001-07-010
Total of all active and inactive participants2001-07-01334
2000: FOLSOM LAKE FORD GROUP WELFARE PLAN 2000 401k membership
Total participants, beginning-of-year2000-07-01334
Total number of active participants reported on line 7a of the Form 55002000-07-01334
Number of retired or separated participants receiving benefits2000-07-010
Number of other retired or separated participants entitled to future benefits2000-07-010
Total of all active and inactive participants2000-07-01334

Form 5500 Responses for FOLSOM LAKE FORD GROUP WELFARE PLAN

2023: FOLSOM LAKE FORD GROUP WELFARE PLAN 2023 form 5500 responses
2023-03-01Type of plan entitySingle employer plan
2023-03-01Plan funding arrangement – InsuranceYes
2023-03-01Plan funding arrangement – General assets of the sponsorYes
2023-03-01Plan benefit arrangement – InsuranceYes
2023-03-01Plan benefit arrangement – General assets of the sponsorYes
2022: FOLSOM LAKE FORD GROUP WELFARE PLAN 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan funding arrangement – General assets of the sponsorYes
2022-03-01Plan benefit arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – General assets of the sponsorYes
2021: FOLSOM LAKE FORD GROUP WELFARE PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan funding arrangement – General assets of the sponsorYes
2021-03-01Plan benefit arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – General assets of the sponsorYes
2020: FOLSOM LAKE FORD GROUP WELFARE PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan funding arrangement – General assets of the sponsorYes
2020-03-01Plan benefit arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – General assets of the sponsorYes
2019: FOLSOM LAKE FORD GROUP WELFARE PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – General assets of the sponsorYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – General assets of the sponsorYes
2017: FOLSOM LAKE FORD GROUP WELFARE PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – General assets of the sponsorYes
2016: FOLSOM LAKE FORD GROUP WELFARE PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – General assets of the sponsorYes
2015: FOLSOM LAKE FORD GROUP WELFARE PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – General assets of the sponsorYes
2014: FOLSOM LAKE FORD GROUP WELFARE PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan funding arrangement – General assets of the sponsorYes
2014-03-01Plan benefit arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – General assets of the sponsorYes
2013: FOLSOM LAKE FORD GROUP WELFARE PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Submission has been amendedNo
2013-03-01This submission is the final filingNo
2013-03-01This return/report is a short plan year return/report (less than 12 months)No
2013-03-01Plan is a collectively bargained planNo
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan funding arrangement – General assets of the sponsorYes
2013-03-01Plan benefit arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – General assets of the sponsorYes
2012: FOLSOM LAKE FORD GROUP WELFARE PLAN 2012 form 5500 responses
2012-03-01Type of plan entityMulitple employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingNo
2012-03-01This return/report is a short plan year return/report (less than 12 months)No
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan funding arrangement – General assets of the sponsorYes
2012-03-01Plan benefit arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – General assets of the sponsorYes
2011: FOLSOM LAKE FORD GROUP WELFARE PLAN 2011 form 5500 responses
2011-03-01Type of plan entityMulitple employer plan
2011-03-01Submission has been amendedNo
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan funding arrangement – General assets of the sponsorYes
2011-03-01Plan benefit arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – General assets of the sponsorYes
2010: FOLSOM LAKE FORD GROUP WELFARE PLAN 2010 form 5500 responses
2010-03-01Type of plan entityMulitple employer plan
2010-03-01Submission has been amendedNo
2010-03-01This submission is the final filingNo
2010-03-01This return/report is a short plan year return/report (less than 12 months)No
2010-03-01Plan is a collectively bargained planNo
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan funding arrangement – General assets of the sponsorYes
2010-03-01Plan benefit arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – General assets of the sponsorYes
2009: FOLSOM LAKE FORD GROUP WELFARE PLAN 2009 form 5500 responses
2009-03-01Type of plan entityMulitple employer plan
2009-03-01Submission has been amendedNo
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan funding arrangement – General assets of the sponsorYes
2009-03-01Plan benefit arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – General assets of the sponsorYes
2008: FOLSOM LAKE FORD GROUP WELFARE PLAN 2008 form 5500 responses
2008-03-01Type of plan entityMulitple employer plan
2008-03-01Submission has been amendedNo
2008-03-01This submission is the final filingNo
2008-03-01This return/report is a short plan year return/report (less than 12 months)No
2008-03-01Plan is a collectively bargained planNo
2008-03-01Plan funding arrangement – InsuranceYes
2008-03-01Plan funding arrangement – General assets of the sponsorYes
2008-03-01Plan benefit arrangement – InsuranceYes
2008-03-01Plan benefit arrangement – General assets of the sponsorYes
2007: FOLSOM LAKE FORD GROUP WELFARE PLAN 2007 form 5500 responses
2007-07-01Type of plan entityMulitple employer plan
2007-07-01Submission has been amendedNo
2007-07-01This submission is the final filingNo
2007-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2007-07-01Plan is a collectively bargained planNo
2007-07-01Plan funding arrangement – InsuranceYes
2007-07-01Plan funding arrangement – General assets of the sponsorYes
2007-07-01Plan benefit arrangement – InsuranceYes
2007-07-01Plan benefit arrangement – General assets of the sponsorYes
2006: FOLSOM LAKE FORD GROUP WELFARE PLAN 2006 form 5500 responses
2006-07-01Type of plan entityMulitple employer plan
2006-07-01Submission has been amendedNo
2006-07-01This submission is the final filingNo
2006-07-01This return/report is a short plan year return/report (less than 12 months)No
2006-07-01Plan is a collectively bargained planNo
2006-07-01Plan funding arrangement – InsuranceYes
2006-07-01Plan funding arrangement – General assets of the sponsorYes
2006-07-01Plan benefit arrangement – InsuranceYes
2006-07-01Plan benefit arrangement – General assets of the sponsorYes
2005: FOLSOM LAKE FORD GROUP WELFARE PLAN 2005 form 5500 responses
2005-07-01Type of plan entityMulitple employer plan
2005-07-01Submission has been amendedNo
2005-07-01This submission is the final filingNo
2005-07-01This return/report is a short plan year return/report (less than 12 months)No
2005-07-01Plan is a collectively bargained planNo
2005-07-01Plan funding arrangement – InsuranceYes
2005-07-01Plan funding arrangement – General assets of the sponsorYes
2005-07-01Plan benefit arrangement – InsuranceYes
2005-07-01Plan benefit arrangement – General assets of the sponsorYes
2004: FOLSOM LAKE FORD GROUP WELFARE PLAN 2004 form 5500 responses
2004-07-01Type of plan entityMulitple employer plan
2004-07-01Submission has been amendedNo
2004-07-01This submission is the final filingNo
2004-07-01This return/report is a short plan year return/report (less than 12 months)No
2004-07-01Plan is a collectively bargained planNo
2004-07-01Plan funding arrangement – InsuranceYes
2004-07-01Plan funding arrangement – General assets of the sponsorYes
2004-07-01Plan benefit arrangement – InsuranceYes
2004-07-01Plan benefit arrangement – General assets of the sponsorYes
2003: FOLSOM LAKE FORD GROUP WELFARE PLAN 2003 form 5500 responses
2003-07-01Type of plan entityMulitple employer plan
2003-07-01Submission has been amendedNo
2003-07-01This submission is the final filingNo
2003-07-01This return/report is a short plan year return/report (less than 12 months)No
2003-07-01Plan is a collectively bargained planNo
2003-07-01Plan funding arrangement – InsuranceYes
2003-07-01Plan funding arrangement – General assets of the sponsorYes
2003-07-01Plan benefit arrangement – InsuranceYes
2003-07-01Plan benefit arrangement – General assets of the sponsorYes
2002: FOLSOM LAKE FORD GROUP WELFARE PLAN 2002 form 5500 responses
2002-07-01Type of plan entityMulitple employer plan
2002-07-01Submission has been amendedNo
2002-07-01This submission is the final filingNo
2002-07-01This return/report is a short plan year return/report (less than 12 months)No
2002-07-01Plan is a collectively bargained planNo
2002-07-01Plan funding arrangement – InsuranceYes
2002-07-01Plan funding arrangement – General assets of the sponsorYes
2002-07-01Plan benefit arrangement – InsuranceYes
2002-07-01Plan benefit arrangement – General assets of the sponsorYes
2001: FOLSOM LAKE FORD GROUP WELFARE PLAN 2001 form 5500 responses
2001-07-01Type of plan entityMulitple employer plan
2001-07-01Submission has been amendedNo
2001-07-01This submission is the final filingNo
2001-07-01This return/report is a short plan year return/report (less than 12 months)No
2001-07-01Plan is a collectively bargained planNo
2001-07-01Plan funding arrangement – InsuranceYes
2001-07-01Plan funding arrangement – General assets of the sponsorYes
2001-07-01Plan benefit arrangement – InsuranceYes
2001-07-01Plan benefit arrangement – General assets of the sponsorYes
2000: FOLSOM LAKE FORD GROUP WELFARE PLAN 2000 form 5500 responses
2000-07-01Type of plan entityMulitple employer plan
2000-07-01Submission has been amendedNo
2000-07-01This submission is the final filingNo
2000-07-01This return/report is a short plan year return/report (less than 12 months)No
2000-07-01Plan is a collectively bargained planNo
2000-07-01Plan funding arrangement – InsuranceYes
2000-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 1
Insurance contract or identification number35204
Number of Individuals Covered166
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
Total amount of commissions paid to insurance brokerUSD $37,274
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,030,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number48175
Policy instance 3
Insurance contract or identification number48175
Number of Individuals Covered231
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
Total amount of commissions paid to insurance brokerUSD $12,560
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $85,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 2
Insurance contract or identification number103992
Number of Individuals Covered49
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
Total amount of commissions paid to insurance brokerUSD $14,438
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $288,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number92325
Policy instance 4
Insurance contract or identification number92325
Number of Individuals Covered63
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
Total amount of commissions paid to insurance brokerUSD $5,961
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $127,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number928869
Policy instance 1
Insurance contract or identification number928869
Number of Individuals Covered234
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $10,023
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $114,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number92325
Policy instance 4
Insurance contract or identification number92325
Number of Individuals Covered69
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $5,742
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $118,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 3
Insurance contract or identification number103992
Number of Individuals Covered56
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $28,731
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $574,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
Insurance contract or identification number35204
Number of Individuals Covered154
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $37,302
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,148,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number928869
Policy instance 1
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number27477
Policy instance 5
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number33492
Policy instance 4
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number33492
Policy instance 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number928869
Policy instance 1
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number27477
Policy instance 5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number928869
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number33492
Policy instance 4
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number27477
Policy instance 5
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number30018834
Policy instance 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 2
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AP86
Policy instance 5
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number92325
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AP86
Policy instance 4
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number33492
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AP86
Policy instance 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30018834
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30018834
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AP86
Policy instance 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 1
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number868476G
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30018834
Policy instance 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number868476G
Policy instance 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30018834
Policy instance 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 1
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number868476G
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30018834
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )
Policy contract number103992
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30002794
Policy instance 3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 4
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 5
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number431472
Policy instance 6
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number526086
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number431472
Policy instance 6
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30002794
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number389722
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 5
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 5
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00000
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 4
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00000
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 4
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00000
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 3
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00000
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 4
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00000
Policy instance 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00000
Policy instance 6
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 5
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-014276-00
Policy instance 4
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00000
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 5
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00000
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00000
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00000
Policy instance 4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10019374
Policy instance 5
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00000
Policy instance 4
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00000
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number35204
Policy instance 2
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract numberM34222
Policy instance 1

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