BAY EAST ASSOCIATION OF REALTORS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM
| Measure | Date | Value |
|---|
| 2023 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-11-30 | $11,360 |
| Total plan liabilities at beginning of year | 2023-11-30 | $10,709 |
| Total income from all sources | 2023-11-30 | $1,283,902 |
| Expenses. Total of all expenses incurred | 2023-11-30 | $1,295,765 |
| Benefits paid (including direct rollovers) | 2023-11-30 | $1,272,189 |
| Total plan assets at beginning of year | 2023-11-30 | $11,212 |
| Total contributions received or receivable from participants | 2023-11-30 | $1,283,902 |
| Expenses. Other expenses not covered elsewhere | 2023-11-30 | $341 |
| Net income (gross income less expenses) | 2023-11-30 | $-11,863 |
| Net plan assets at end of year (total assets less liabilities) | 2023-11-30 | $-11,360 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-11-30 | $503 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-11-30 | $23,235 |
| 2022 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $1,682,282 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $1,658,811 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $1,627,799 |
| Total plan assets at end of year | 2022-12-31 | $503 |
| Total plan assets at beginning of year | 2022-12-31 | $-22,968 |
| Total contributions received or receivable from participants | 2022-12-31 | $1,682,282 |
| Net income (gross income less expenses) | 2022-12-31 | $23,471 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $503 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-22,968 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $31,012 |
| 2021 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $37,220 |
| Total plan liabilities at beginning of year | 2021-12-31 | $38,749 |
| Total income from all sources | 2021-12-31 | $1,900,516 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $1,946,754 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $1,910,741 |
| Total plan assets at end of year | 2021-12-31 | $-22,968 |
| Total plan assets at beginning of year | 2021-12-31 | $24,799 |
| Total contributions received or receivable from participants | 2021-12-31 | $1,901,309 |
| Other income received | 2021-12-31 | $-793 |
| Net income (gross income less expenses) | 2021-12-31 | $-46,238 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $-60,188 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $-13,950 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $36,013 |
| 2020 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $38,749 |
| Total plan liabilities at beginning of year | 2020-12-31 | $37,220 |
| Total income from all sources | 2020-12-31 | $2,149,147 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $2,155,018 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $2,113,671 |
| Total plan assets at end of year | 2020-12-31 | $24,799 |
| Total plan assets at beginning of year | 2020-12-31 | $29,141 |
| Total contributions received or receivable from participants | 2020-12-31 | $2,150,020 |
| Other income received | 2020-12-31 | $-873 |
| Net income (gross income less expenses) | 2020-12-31 | $-5,871 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $-13,950 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-8,079 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $41,347 |
| 2019 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $37,220 |
| Total plan liabilities at beginning of year | 2019-12-31 | $37,220 |
| Total income from all sources | 2019-12-31 | $2,393,899 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $2,431,425 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $2,375,400 |
| Total plan assets at end of year | 2019-12-31 | $29,141 |
| Total plan assets at beginning of year | 2019-12-31 | $66,667 |
| Total contributions received or receivable from participants | 2019-12-31 | $2,395,472 |
| Other income received | 2019-12-31 | $-1,573 |
| Net income (gross income less expenses) | 2019-12-31 | $-37,526 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $-8,079 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $29,447 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $56,025 |
| 2018 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $37,220 |
| Total plan liabilities at beginning of year | 2018-12-31 | $60,237 |
| Total income from all sources | 2018-12-31 | $2,188,261 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $2,158,375 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $2,115,970 |
| Total plan assets at end of year | 2018-12-31 | $66,667 |
| Total plan assets at beginning of year | 2018-12-31 | $59,798 |
| Total contributions received or receivable from participants | 2018-12-31 | $2,189,903 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $42,405 |
| Other income received | 2018-12-31 | $-1,642 |
| Net income (gross income less expenses) | 2018-12-31 | $29,886 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $29,447 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-439 |
| 2017 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $60,237 |
| Total plan liabilities at beginning of year | 2017-12-31 | $37,220 |
| Total income from all sources | 2017-12-31 | $1,866,709 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,858,958 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $1,817,653 |
| Total plan assets at end of year | 2017-12-31 | $59,798 |
| Total plan assets at beginning of year | 2017-12-31 | $29,030 |
| Total contributions received or receivable from participants | 2017-12-31 | $1,867,906 |
| Other income received | 2017-12-31 | $-1,197 |
| Net income (gross income less expenses) | 2017-12-31 | $7,751 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $-439 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-8,190 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $41,305 |
| 2016 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $37,220 |
| Total plan liabilities at beginning of year | 2016-12-31 | $105,390 |
| Total income from all sources | 2016-12-31 | $1,694,457 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $1,744,901 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $1,707,558 |
| Total plan assets at end of year | 2016-12-31 | $29,030 |
| Total plan assets at beginning of year | 2016-12-31 | $147,644 |
| Total contributions received or receivable from participants | 2016-12-31 | $1,696,352 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $119 |
| Other income received | 2016-12-31 | $-1,895 |
| Net income (gross income less expenses) | 2016-12-31 | $-50,444 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $-8,190 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $42,254 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $37,224 |
| 2015 : BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $105,390 |
| Total plan liabilities at beginning of year | 2015-12-31 | $37,220 |
| Total income from all sources | 2015-12-31 | $1,673,269 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,698,229 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,654,458 |
| Total plan assets at end of year | 2015-12-31 | $147,643 |
| Total plan assets at beginning of year | 2015-12-31 | $104,433 |
| Total contributions received or receivable from participants | 2015-12-31 | $1,675,947 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $-10 |
| Other income received | 2015-12-31 | $-2,678 |
| Net income (gross income less expenses) | 2015-12-31 | $-24,960 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $42,253 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $67,213 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $43,781 |
| 2023: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Mulitple employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Mulitple employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | Yes |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Mulitple employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Mulitple employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Multi-employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Multi-employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Multi-employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Multi-employer plan |
| 2016-01-01 | First time form 5500 has been submitted | Yes |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Multi-employer plan |
| 2015-01-01 | First time form 5500 has been submitted | Yes |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | First time form 5500 has been submitted | Yes |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BAY EAST ASSOCIATION OF REALTORS MEMBER BENEFITS PROGRAM 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Mulitple employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 232813 |
| Policy instance | 4 |
| Insurance contract or identification number | 232813 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $260 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 3 |
| Insurance contract or identification number | 76266 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $573 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $5,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 2 |
| Insurance contract or identification number | 07314 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $2,262 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10915003 |
| Policy instance | 1 |
| Insurance contract or identification number | 10915003 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $594 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $5,914 | | 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 | 607974 |
| Policy instance | 5 |
| Insurance contract or identification number | 607974 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $38,791 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,134,274 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 05890 |
| Policy instance | 5 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 4 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 3 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 604974 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 232813 |
| Policy instance | 1 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 76266 |
| Policy instance | 6 |
| NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10915 |
| Policy instance | 7 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 76266 |
| Policy instance | 3 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 05890 |
| Policy instance | 4 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 5 |
| NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10915 |
| Policy instance | 6 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 7 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 904974 |
| Policy instance | 1 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 2 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 05890 |
| Policy instance | 4 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 38350 |
| Policy instance | 5 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 38350 |
| Policy instance | 5 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 05890 |
| Policy instance | 4 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 604974 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 604974 |
| Policy instance | 1 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 05890 |
| Policy instance | 2 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 38350 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 4 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 5 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 38350 |
| Policy instance | 5 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 05890 |
| Policy instance | 4 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 604974 |
| Policy instance | 1 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 233-007 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 604974 |
| Policy instance | 2 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 4 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 233-007 |
| Policy instance | 4 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 637697 ET AL |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 637697 ET AL |
| Policy instance | 1 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 233-007 |
| Policy instance | 2 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 07314 |
| Policy instance | 4 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 637697 ET AL |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 76266/07314 |
| Policy instance | 2 |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 233-007 |
| Policy instance | 1 |
