UCBT RETIREE HEALTH PLAN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UFCW COMPREHENSIVE BENEFITS TRUST
| Measure | Date | Value |
|---|
| 2023 : UFCW COMPREHENSIVE BENEFITS TRUST 2023 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $9,468,390 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $7,489,009 |
| Total income from all sources (including contributions) | 2023-12-31 | $31,815,512 |
| Total of all expenses incurred | 2023-12-31 | $28,044,632 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $26,185,799 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $31,490,614 |
| Value of total assets at end of year | 2023-12-31 | $18,767,646 |
| Value of total assets at beginning of year | 2023-12-31 | $13,017,385 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $1,858,833 |
| Total interest from all sources | 2023-12-31 | $322,291 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-12-31 | No |
| Was this plan covered by a fidelity bond | 2023-12-31 | Yes |
| Value of fidelity bond cover | 2023-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2023-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $1,291,347 |
| Participant contributions at end of year | 2023-12-31 | $109,226 |
| Participant contributions at beginning of year | 2023-12-31 | $86,491 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $229,324 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $550,541 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-12-31 | $4,122,517 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-12-31 | $2,145,299 |
| Other income not declared elsewhere | 2023-12-31 | $2,607 |
| Administrative expenses (other) incurred | 2023-12-31 | $682,213 |
| Liabilities. Value of operating payables at end of year | 2023-12-31 | $58,896 |
| Liabilities. Value of operating payables at beginning of year | 2023-12-31 | $16,748 |
| Total non interest bearing cash at end of year | 2023-12-31 | $6,015,280 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $4,701,811 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Value of net income/loss | 2023-12-31 | $3,770,880 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $9,299,256 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $5,528,376 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-12-31 | $9,338,580 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-12-31 | $5,082,386 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-12-31 | $5,082,386 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-12-31 | $322,291 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $7,350,358 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $30,199,267 |
| Employer contributions (assets) at end of year | 2023-12-31 | $3,075,236 |
| Employer contributions (assets) at beginning of year | 2023-12-31 | $2,596,156 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $18,835,441 |
| Contract administrator fees | 2023-12-31 | $827,943 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2023-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $5,286,977 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $5,326,962 |
| Did the plan have assets held for investment | 2023-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | EIDE BAILLY LLP |
| Accountancy firm EIN | 2023-12-31 | 450250958 |
| 2022 : UFCW COMPREHENSIVE BENEFITS TRUST 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $7,489,009 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $7,472,992 |
| Total income from all sources (including contributions) | 2022-12-31 | $26,249,715 |
| Total of all expenses incurred | 2022-12-31 | $24,704,842 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $22,964,119 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $26,161,793 |
| Value of total assets at end of year | 2022-12-31 | $13,017,385 |
| Value of total assets at beginning of year | 2022-12-31 | $11,456,495 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $1,740,723 |
| Total interest from all sources | 2022-12-31 | $70,880 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $735,770 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $1,249,962 |
| Participant contributions at end of year | 2022-12-31 | $86,491 |
| Participant contributions at beginning of year | 2022-12-31 | $87,661 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $550,541 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $177,017 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $2,145,299 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $1,999,031 |
| Other income not declared elsewhere | 2022-12-31 | $17,042 |
| Administrative expenses (other) incurred | 2022-12-31 | $181,676 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $16,748 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $61,030 |
| Total non interest bearing cash at end of year | 2022-12-31 | $4,701,811 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $4,045,082 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $1,544,873 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $5,528,376 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $3,983,503 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $750 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $5,082,386 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $5,031,546 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $5,031,546 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $70,880 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $6,534,216 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $24,911,831 |
| Employer contributions (assets) at end of year | 2022-12-31 | $2,596,156 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $2,115,189 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $16,429,903 |
| Contract administrator fees | 2022-12-31 | $822,527 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $5,326,962 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $5,412,931 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | EIDE BAILLY LLP |
| Accountancy firm EIN | 2022-12-31 | 450250958 |
| 2021 : UFCW COMPREHENSIVE BENEFITS TRUST 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $7,472,992 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $5,288,664 |
| Total income from all sources (including contributions) | 2021-12-31 | $27,087,983 |
| Total of all expenses incurred | 2021-12-31 | $28,499,459 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $26,766,426 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $27,079,098 |
| Value of total assets at end of year | 2021-12-31 | $11,456,495 |
| Value of total assets at beginning of year | 2021-12-31 | $10,683,643 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $1,733,033 |
| Total interest from all sources | 2021-12-31 | $8,201 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $806,109 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $1,246,933 |
| Participant contributions at end of year | 2021-12-31 | $87,661 |
| Participant contributions at beginning of year | 2021-12-31 | $103,910 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $100,101 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $177,017 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $217,123 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $1,999,031 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $2,998,264 |
| Other income not declared elsewhere | 2021-12-31 | $684 |
| Administrative expenses (other) incurred | 2021-12-31 | $123,583 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $61,030 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $15,196 |
| Total non interest bearing cash at end of year | 2021-12-31 | $4,045,082 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $6,099,917 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-1,411,476 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $3,983,503 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $5,394,979 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $750 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $5,031,546 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $2,032,155 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $2,032,155 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $8,201 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $7,940,614 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $25,732,064 |
| Employer contributions (assets) at end of year | 2021-12-31 | $2,115,189 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $2,230,538 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $18,825,812 |
| Contract administrator fees | 2021-12-31 | $802,591 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $5,412,931 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $2,275,204 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | EIDE BAILLY, LLP |
| Accountancy firm EIN | 2021-12-31 | 450250958 |
| 2020 : UFCW COMPREHENSIVE BENEFITS TRUST 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $5,288,664 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $3,356,860 |
| Total income from all sources (including contributions) | 2020-12-31 | $27,647,381 |
| Total of all expenses incurred | 2020-12-31 | $24,792,943 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $23,203,854 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $27,627,333 |
| Value of total assets at end of year | 2020-12-31 | $10,683,643 |
| Value of total assets at beginning of year | 2020-12-31 | $5,897,401 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $1,589,089 |
| Total interest from all sources | 2020-12-31 | $20,048 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $855,863 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $1,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $1,223,809 |
| Participant contributions at end of year | 2020-12-31 | $103,910 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $217,123 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $2,582 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $2,998,264 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $1,297,589 |
| Administrative expenses (other) incurred | 2020-12-31 | $100,211 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $15,196 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $34,807 |
| Total non interest bearing cash at end of year | 2020-12-31 | $6,099,917 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $2,426,046 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $2,854,438 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $5,394,979 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $2,540,541 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Investment advisory and management fees | 2020-12-31 | $4,725 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $2,032,155 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $2,022,252 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $2,022,252 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $20,048 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $7,340,077 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $26,403,524 |
| Employer contributions (assets) at end of year | 2020-12-31 | $2,230,538 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $1,446,521 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $15,863,777 |
| Contract administrator fees | 2020-12-31 | $628,290 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $2,275,204 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $2,024,464 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | EIDE BAILLY LLP |
| Accountancy firm EIN | 2020-12-31 | 450250958 |
| 2019 : UFCW COMPREHENSIVE BENEFITS TRUST 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $3,356,860 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $2,236,236 |
| Total income from all sources (including contributions) | 2019-12-31 | $12,073,829 |
| Total of all expenses incurred | 2019-12-31 | $12,683,629 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $11,728,557 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $11,949,295 |
| Value of total assets at end of year | 2019-12-31 | $5,897,401 |
| Value of total assets at beginning of year | 2019-12-31 | $5,386,577 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $955,072 |
| Total interest from all sources | 2019-12-31 | $78,360 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $451,814 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $762,051 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $2,582 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $1,297,589 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $1,219,679 |
| Other income not declared elsewhere | 2019-12-31 | $46,174 |
| Administrative expenses (other) incurred | 2019-12-31 | $77,589 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $34,807 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $667 |
| Total non interest bearing cash at end of year | 2019-12-31 | $2,426,046 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $4,192,692 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $-609,800 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $2,540,541 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $3,150,341 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $2,022,252 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $78,360 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,670,936 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $11,187,244 |
| Employer contributions (assets) at end of year | 2019-12-31 | $1,446,521 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $1,193,885 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $9,057,621 |
| Contract administrator fees | 2019-12-31 | $425,669 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $2,024,464 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $1,015,890 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | EIDE BAILLY LLP |
| Accountancy firm EIN | 2019-12-31 | 450250958 |
| 2018 : UFCW COMPREHENSIVE BENEFITS TRUST 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $2,236,236 |
| Total income from all sources (including contributions) | 2018-12-31 | $15,024,613 |
| Total of all expenses incurred | 2018-12-31 | $11,874,272 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $10,884,366 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $14,898,144 |
| Value of total assets at end of year | 2018-12-31 | $5,386,577 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $989,906 |
| Total interest from all sources | 2018-12-31 | $22,903 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $467,513 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $1,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $537,243 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $1,219,679 |
| Other income not declared elsewhere | 2018-12-31 | $103,566 |
| Administrative expenses (other) incurred | 2018-12-31 | $97,264 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $667 |
| Total non interest bearing cash at end of year | 2018-12-31 | $4,192,692 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $3,150,341 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $3,150,341 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $22,903 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $3,314,282 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $14,360,901 |
| Employer contributions (assets) at end of year | 2018-12-31 | $1,193,885 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $7,570,084 |
| Contract administrator fees | 2018-12-31 | $425,129 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $1,015,890 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | EIDE BAILLY LLP |
| Accountancy firm EIN | 2018-12-31 | 450250958 |
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-000347 |
| Policy instance | 5 |
| Insurance contract or identification number | 47-MSL-000347 | | Number of Individuals Covered | 1313 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $71,803 | | Welfare Benefit Premiums Paid to Carrier | USD $1,436,058 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-3 |
| Policy instance | 4 |
| Insurance contract or identification number | 53095-3 | | Number of Individuals Covered | 2477 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 102001 |
| Policy instance | 3 |
| Insurance contract or identification number | 102001 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 53095-1 | | Number of Individuals Covered | 4291 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 605686 |
| Policy instance | 1 |
| Insurance contract or identification number | 605686 | | Number of Individuals Covered | 893 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,520,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 605686 |
| Policy instance | 1 |
| Insurance contract or identification number | 605686 | | Number of Individuals Covered | 1087 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,112,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 53095-1 | | Number of Individuals Covered | 4577 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,013 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-000347-0 |
| Policy instance | 3 |
| Insurance contract or identification number | 47-MSL-000347-0 | | Number of Individuals Covered | 1269 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $64,462 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,255,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,462 | | Additional information about fees paid to insurance broker | COMMISSION FEES | | Insurance broker organization code? | 3 |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 102001 |
| Policy instance | 4 |
| Insurance contract or identification number | 102001 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-3 |
| Policy instance | 5 |
| Insurance contract or identification number | 53095-3 | | Number of Individuals Covered | 2618 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-3 |
| Policy instance | 5 |
| Insurance contract or identification number | 53095-3 | | Number of Individuals Covered | 2483 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,854 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 102001 |
| Policy instance | 4 |
| Insurance contract or identification number | 102001 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-000347-0 |
| Policy instance | 3 |
| Insurance contract or identification number | 47-MSL-000347-0 | | Number of Individuals Covered | 1322 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $58,117 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,162,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,117 | | Additional information about fees paid to insurance broker | COMMISSION FEES | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 53095-1 | | Number of Individuals Covered | 4363 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 605686 |
| Policy instance | 1 |
| Insurance contract or identification number | 605686 | | Number of Individuals Covered | 1050 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,940,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-000347-0 |
| Policy instance | 6 |
| Insurance contract or identification number | 47-MSL-000347-0 | | Number of Individuals Covered | 1358 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $42,323 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,050,399 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,323 | | Additional information about fees paid to insurance broker | COMMISSION FEES | | Insurance broker organization code? | 3 |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 102001 |
| Policy instance | 5 |
| Insurance contract or identification number | 102001 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-3 |
| Policy instance | 4 |
| Insurance contract or identification number | 53095-3 | | Number of Individuals Covered | 2651 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-1 |
| Policy instance | 3 |
| Insurance contract or identification number | 53095-1 | | Number of Individuals Covered | 4526 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0065194 |
| Policy instance | 2 |
| Insurance contract or identification number | W0065194 | | Number of Individuals Covered | 822 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $59,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 605686 |
| Policy instance | 1 |
| Insurance contract or identification number | 605686 | | Number of Individuals Covered | 1129 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,270,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0065194 |
| Policy instance | 2 |
| Insurance contract or identification number | W0065194 | | Number of Individuals Covered | 842 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $397,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-1 |
| Policy instance | 3 |
| Insurance contract or identification number | 53095-1 | | Number of Individuals Covered | 2473 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-3 |
| Policy instance | 4 |
| Insurance contract or identification number | 53095-3 | | Number of Individuals Covered | 1304 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 102001 |
| Policy instance | 5 |
| Insurance contract or identification number | 102001 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 605686 |
| Policy instance | 1 |
| Insurance contract or identification number | 605686 | | Number of Individuals Covered | 496 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,208,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 605686 |
| Policy instance | 1 |
| Insurance contract or identification number | 605686 | | Number of Individuals Covered | 486 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,279,551 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | W0065194 |
| Policy instance | 2 |
| Insurance contract or identification number | W0065194 | | Number of Individuals Covered | 639 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $451,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-3 |
| Policy instance | 4 |
| Insurance contract or identification number | 53095-3 | | Number of Individuals Covered | 784 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 102001 |
| Policy instance | 5 |
| Insurance contract or identification number | 102001 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53095-1 |
| Policy instance | 3 |
| Insurance contract or identification number | 53095-1 | | Number of Individuals Covered | 1499 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,050 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
