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MFOW WELFARE FUND 401k Plan overview

Plan NameMFOW WELFARE FUND
Plan identification number 501

MFOW WELFARE FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BOARD OF TRUSTEES OF MFOW WELFARE FUND has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES OF MFOW WELFARE FUND
Employer identification number (EIN):941254186
NAIC Classification:483000
NAIC Description: Water Transportation

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MFOW WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01DANNY DEFANTI2023-11-14 ANTHONY POPLAWSKI2023-11-14
5012021-02-01THOMAS E. PERCIVAL2022-11-14 ANTHONY POPLAWSKI2022-11-14
5012020-02-01
5012019-02-01
5012018-02-01
5012017-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2018-09-25
5012016-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2017-11-03
5012015-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2016-10-28
5012014-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2015-10-21
5012013-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2014-09-18
5012012-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2013-10-07
5012011-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2012-10-02
5012010-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2011-09-19
5012009-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2010-11-09
5012009-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2010-11-08
5012009-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2010-11-09
5012009-02-01THOMAS E. PERCIVAL ANTHONY POPLAWSKI2010-11-08

Plan Statistics for MFOW WELFARE FUND

401k plan membership statisitcs for MFOW WELFARE FUND

Measure Date Value
2022: MFOW WELFARE FUND 2022 401k membership
Total participants, beginning-of-year2022-02-01393
Total number of active participants reported on line 7a of the Form 55002022-02-01295
Number of retired or separated participants receiving benefits2022-02-01110
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01405
Number of employers contributing to the scheme2022-02-014
2021: MFOW WELFARE FUND 2021 401k membership
Total participants, beginning-of-year2021-02-01559
Total number of active participants reported on line 7a of the Form 55002021-02-01283
Number of retired or separated participants receiving benefits2021-02-01110
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01393
Number of employers contributing to the scheme2021-02-014
2020: MFOW WELFARE FUND 2020 401k membership
Total participants, beginning-of-year2020-02-01423
Total number of active participants reported on line 7a of the Form 55002020-02-01425
Number of retired or separated participants receiving benefits2020-02-01134
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01559
Number of employers contributing to the scheme2020-02-014
2019: MFOW WELFARE FUND 2019 401k membership
Total participants, beginning-of-year2019-02-01404
Total number of active participants reported on line 7a of the Form 55002019-02-01304
Number of retired or separated participants receiving benefits2019-02-01119
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01423
Number of employers contributing to the scheme2019-02-014
2018: MFOW WELFARE FUND 2018 401k membership
Total participants, beginning-of-year2018-02-01454
Total number of active participants reported on line 7a of the Form 55002018-02-01304
Number of retired or separated participants receiving benefits2018-02-01126
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01430
Number of employers contributing to the scheme2018-02-014
2017: MFOW WELFARE FUND 2017 401k membership
Total participants, beginning-of-year2017-02-01444
Total number of active participants reported on line 7a of the Form 55002017-02-01310
Number of retired or separated participants receiving benefits2017-02-01144
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01454
Number of employers contributing to the scheme2017-02-015
2016: MFOW WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-02-01450
Total number of active participants reported on line 7a of the Form 55002016-02-01287
Number of retired or separated participants receiving benefits2016-02-01157
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01444
Number of employers contributing to the scheme2016-02-015
2015: MFOW WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-02-01485
Total number of active participants reported on line 7a of the Form 55002015-02-01280
Number of retired or separated participants receiving benefits2015-02-01172
Number of other retired or separated participants entitled to future benefits2015-02-0135
Total of all active and inactive participants2015-02-01487
Number of employers contributing to the scheme2015-02-014
2014: MFOW WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-02-01485
Total number of active participants reported on line 7a of the Form 55002014-02-01261
Number of retired or separated participants receiving benefits2014-02-01186
Number of other retired or separated participants entitled to future benefits2014-02-0138
Total of all active and inactive participants2014-02-01485
Number of employers contributing to the scheme2014-02-014
2013: MFOW WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-02-01508
Total number of active participants reported on line 7a of the Form 55002013-02-01247
Number of retired or separated participants receiving benefits2013-02-01191
Number of other retired or separated participants entitled to future benefits2013-02-0147
Total of all active and inactive participants2013-02-01485
Number of employers contributing to the scheme2013-02-014
2012: MFOW WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-02-01513
Total number of active participants reported on line 7a of the Form 55002012-02-01264
Number of retired or separated participants receiving benefits2012-02-01199
Number of other retired or separated participants entitled to future benefits2012-02-0145
Total of all active and inactive participants2012-02-01508
Number of employers contributing to the scheme2012-02-013
2011: MFOW WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-02-01491
Total number of active participants reported on line 7a of the Form 55002011-02-01265
Number of retired or separated participants receiving benefits2011-02-01248
Number of other retired or separated participants entitled to future benefits2011-02-010
Total of all active and inactive participants2011-02-01513
Number of employers contributing to the scheme2011-02-013
2010: MFOW WELFARE FUND 2010 401k membership
Total participants, beginning-of-year2010-02-01495
Total number of active participants reported on line 7a of the Form 55002010-02-01255
Number of retired or separated participants receiving benefits2010-02-01236
Number of other retired or separated participants entitled to future benefits2010-02-010
Total of all active and inactive participants2010-02-01491
Number of employers contributing to the scheme2010-02-013
2009: MFOW WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-02-01559
Total number of active participants reported on line 7a of the Form 55002009-02-01242
Number of retired or separated participants receiving benefits2009-02-01253
Number of other retired or separated participants entitled to future benefits2009-02-010
Total of all active and inactive participants2009-02-01495
Number of employers contributing to the scheme2009-02-013

Financial Data on MFOW WELFARE FUND

Measure Date Value
2023 : MFOW WELFARE FUND 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2023-01-31$-398,475
Total unrealized appreciation/depreciation of assets2023-01-31$-398,475
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-01-31$347,898
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-01-31$299,250
Total income from all sources (including contributions)2023-01-31$5,258,507
Total loss/gain on sale of assets2023-01-31$-114,144
Total of all expenses incurred2023-01-31$6,003,353
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-01-31$5,203,838
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-01-31$5,426,209
Value of total assets at end of year2023-01-31$13,846,808
Value of total assets at beginning of year2023-01-31$14,543,006
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-01-31$799,515
Total interest from all sources2023-01-31$288,290
Total dividends received (eg from common stock, registered investment company shares)2023-01-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-01-31No
Administrative expenses professional fees incurred2023-01-31$162,233
Was this plan covered by a fidelity bond2023-01-31Yes
Value of fidelity bond cover2023-01-31$500,000
Were there any nonexempt tranactions with any party-in-interest2023-01-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-01-31$78,174
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-01-31$66,323
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-01-31$197,648
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-01-31$0
Other income not declared elsewhere2023-01-31$56,627
Administrative expenses (other) incurred2023-01-31$552,230
Liabilities. Value of operating payables at end of year2023-01-31$3,250
Liabilities. Value of operating payables at beginning of year2023-01-31$3,250
Total non interest bearing cash at end of year2023-01-31$260,943
Total non interest bearing cash at beginning of year2023-01-31$262,226
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-01-31No
Value of net income/loss2023-01-31$-744,846
Value of net assets at end of year (total assets less liabilities)2023-01-31$13,498,910
Value of net assets at beginning of year (total assets less liabilities)2023-01-31$14,243,756
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-01-31No
Were any leases to which the plan was party in default or uncollectible2023-01-31No
Investment advisory and management fees2023-01-31$52,876
Income. Interest from US Government securities2023-01-31$109,627
Income. Interest from corporate debt instruments2023-01-31$172,271
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-01-31$630,381
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-01-31$987,565
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-01-31$987,565
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-01-31$6,392
Expenses. Payments to insurance carriers foe the provision of benefits2023-01-31$3,535,007
Asset value of US Government securities at end of year2023-01-31$5,756,776
Asset value of US Government securities at beginning of year2023-01-31$8,274,886
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-01-31Yes
Was there a failure to transmit to the plan any participant contributions2023-01-31No
Has the plan failed to provide any benefit when due under the plan2023-01-31No
Contributions received in cash from employer2023-01-31$5,426,209
Employer contributions (assets) at end of year2023-01-31$438,000
Employer contributions (assets) at beginning of year2023-01-31$453,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-01-31$1,668,831
Asset. Corporate debt instrument debt (other) at end of year2023-01-31$6,682,534
Asset. Corporate debt instrument debt (other) at beginning of year2023-01-31$4,499,006
Contract administrator fees2023-01-31$32,176
Liabilities. Value of benefit claims payable at end of year2023-01-31$147,000
Liabilities. Value of benefit claims payable at beginning of year2023-01-31$296,000
Did the plan have assets held for investment2023-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-01-31No
Aggregate proceeds on sale of assets2023-01-31$7,082,110
Aggregate carrying amount (costs) on sale of assets2023-01-31$7,196,254
Opinion of an independent qualified public accountant for this plan2023-01-31Unqualified
Accountancy firm name2023-01-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2023-01-31222027092
2022 : MFOW WELFARE FUND 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-01-31$-315,808
Total unrealized appreciation/depreciation of assets2022-01-31$-315,808
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-01-31$299,250
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-01-31$193,250
Total income from all sources (including contributions)2022-01-31$5,441,686
Total loss/gain on sale of assets2022-01-31$-95,728
Total of all expenses incurred2022-01-31$5,694,319
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-01-31$4,903,574
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-01-31$5,457,059
Value of total assets at end of year2022-01-31$14,543,006
Value of total assets at beginning of year2022-01-31$14,689,639
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-01-31$790,745
Total interest from all sources2022-01-31$243,916
Total dividends received (eg from common stock, registered investment company shares)2022-01-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-01-31No
Administrative expenses professional fees incurred2022-01-31$178,293
Was this plan covered by a fidelity bond2022-01-31Yes
Value of fidelity bond cover2022-01-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-01-31No
Contributions received from participants2022-01-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-01-31$66,323
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-01-31$68,514
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-01-31$3,250
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-01-31$3,250
Other income not declared elsewhere2022-01-31$152,247
Administrative expenses (other) incurred2022-01-31$518,673
Total non interest bearing cash at end of year2022-01-31$262,226
Total non interest bearing cash at beginning of year2022-01-31$94,081
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-01-31No
Value of net income/loss2022-01-31$-252,633
Value of net assets at end of year (total assets less liabilities)2022-01-31$14,243,756
Value of net assets at beginning of year (total assets less liabilities)2022-01-31$14,496,389
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-01-31No
Were any leases to which the plan was party in default or uncollectible2022-01-31No
Investment advisory and management fees2022-01-31$58,565
Income. Interest from US Government securities2022-01-31$128,019
Income. Interest from corporate debt instruments2022-01-31$115,690
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-01-31$987,565
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-01-31$1,208,533
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-01-31$1,208,533
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-01-31$207
Expenses. Payments to insurance carriers foe the provision of benefits2022-01-31$3,214,356
Asset value of US Government securities at end of year2022-01-31$8,274,886
Asset value of US Government securities at beginning of year2022-01-31$7,995,026
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-01-31Yes
Was there a failure to transmit to the plan any participant contributions2022-01-31No
Has the plan failed to provide any benefit when due under the plan2022-01-31No
Contributions received in cash from employer2022-01-31$5,457,059
Employer contributions (assets) at end of year2022-01-31$453,000
Employer contributions (assets) at beginning of year2022-01-31$426,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-01-31$1,689,218
Asset. Corporate debt instrument debt (other) at end of year2022-01-31$4,499,006
Asset. Corporate debt instrument debt (other) at beginning of year2022-01-31$4,897,485
Contract administrator fees2022-01-31$35,214
Liabilities. Value of benefit claims payable at end of year2022-01-31$296,000
Liabilities. Value of benefit claims payable at beginning of year2022-01-31$190,000
Did the plan have assets held for investment2022-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-01-31No
Aggregate proceeds on sale of assets2022-01-31$10,229,637
Aggregate carrying amount (costs) on sale of assets2022-01-31$10,325,365
Opinion of an independent qualified public accountant for this plan2022-01-31Unqualified
Accountancy firm name2022-01-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2022-01-31222027092
2021 : MFOW WELFARE FUND 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-01-31$148,702
Total unrealized appreciation/depreciation of assets2021-01-31$148,702
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-01-31$193,250
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-01-31$464,054
Total income from all sources (including contributions)2021-01-31$5,557,794
Total loss/gain on sale of assets2021-01-31$5,878
Total of all expenses incurred2021-01-31$4,997,548
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-01-31$4,232,797
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-01-31$5,037,731
Value of total assets at end of year2021-01-31$14,689,639
Value of total assets at beginning of year2021-01-31$14,400,197
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-01-31$764,751
Total interest from all sources2021-01-31$321,431
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-01-31No
Administrative expenses professional fees incurred2021-01-31$123,152
Was this plan covered by a fidelity bond2021-01-31Yes
Value of fidelity bond cover2021-01-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-01-31No
Contributions received from participants2021-01-31$4,564
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-01-31$68,514
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-01-31$103,727
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-01-31$3,250
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-01-31$50,054
Other income not declared elsewhere2021-01-31$44,052
Administrative expenses (other) incurred2021-01-31$538,104
Total non interest bearing cash at end of year2021-01-31$94,081
Total non interest bearing cash at beginning of year2021-01-31$621,794
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-01-31No
Value of net income/loss2021-01-31$560,246
Value of net assets at end of year (total assets less liabilities)2021-01-31$14,496,389
Value of net assets at beginning of year (total assets less liabilities)2021-01-31$13,936,143
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-01-31No
Were any leases to which the plan was party in default or uncollectible2021-01-31No
Investment advisory and management fees2021-01-31$61,263
Income. Interest from US Government securities2021-01-31$171,509
Income. Interest from corporate debt instruments2021-01-31$148,605
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-01-31$1,208,533
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-01-31$669,878
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-01-31$669,878
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-01-31$1,317
Expenses. Payments to insurance carriers foe the provision of benefits2021-01-31$2,946,019
Asset value of US Government securities at end of year2021-01-31$7,995,026
Asset value of US Government securities at beginning of year2021-01-31$7,841,840
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-01-31Yes
Was there a failure to transmit to the plan any participant contributions2021-01-31No
Has the plan failed to provide any benefit when due under the plan2021-01-31No
Contributions received in cash from employer2021-01-31$5,033,167
Employer contributions (assets) at end of year2021-01-31$426,000
Employer contributions (assets) at beginning of year2021-01-31$436,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-01-31$1,286,778
Asset. Corporate debt instrument debt (other) at end of year2021-01-31$4,897,485
Asset. Corporate debt instrument debt (other) at beginning of year2021-01-31$4,726,958
Contract administrator fees2021-01-31$42,232
Liabilities. Value of benefit claims payable at end of year2021-01-31$190,000
Liabilities. Value of benefit claims payable at beginning of year2021-01-31$414,000
Did the plan have assets held for investment2021-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-01-31No
Aggregate proceeds on sale of assets2021-01-31$12,530,760
Aggregate carrying amount (costs) on sale of assets2021-01-31$12,524,882
Opinion of an independent qualified public accountant for this plan2021-01-31Unqualified
Accountancy firm name2021-01-31LINDQUIST LLP
Accountancy firm EIN2021-01-31522385296
2020 : MFOW WELFARE FUND 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-01-31$210,334
Unrealized appreciation/depreciation of other (non real estate) assets2020-01-31$210,334
Total unrealized appreciation/depreciation of assets2020-01-31$210,334
Total unrealized appreciation/depreciation of assets2020-01-31$210,334
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-01-31$464,054
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-01-31$464,054
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-01-31$105,250
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-01-31$105,250
Total income from all sources (including contributions)2020-01-31$6,002,047
Total income from all sources (including contributions)2020-01-31$6,002,047
Total loss/gain on sale of assets2020-01-31$8,252
Total loss/gain on sale of assets2020-01-31$8,252
Total of all expenses incurred2020-01-31$6,154,621
Total of all expenses incurred2020-01-31$6,154,621
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-01-31$5,289,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-01-31$5,289,226
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-01-31$5,357,424
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-01-31$5,357,424
Value of total assets at end of year2020-01-31$14,400,197
Value of total assets at end of year2020-01-31$14,400,197
Value of total assets at beginning of year2020-01-31$14,193,967
Value of total assets at beginning of year2020-01-31$14,193,967
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-01-31$865,395
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-01-31$865,395
Total interest from all sources2020-01-31$369,696
Total interest from all sources2020-01-31$369,696
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-01-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-01-31No
Administrative expenses professional fees incurred2020-01-31$158,914
Administrative expenses professional fees incurred2020-01-31$158,914
Was this plan covered by a fidelity bond2020-01-31Yes
Was this plan covered by a fidelity bond2020-01-31Yes
Value of fidelity bond cover2020-01-31$500,000
Value of fidelity bond cover2020-01-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-01-31No
Were there any nonexempt tranactions with any party-in-interest2020-01-31No
Contributions received from participants2020-01-31$1,215
Contributions received from participants2020-01-31$1,215
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-01-31$103,727
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-01-31$103,727
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-01-31$101,144
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-01-31$101,144
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-01-31$50,054
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-01-31$50,054
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-01-31$3,250
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-01-31$3,250
Other income not declared elsewhere2020-01-31$56,341
Other income not declared elsewhere2020-01-31$56,341
Administrative expenses (other) incurred2020-01-31$602,216
Administrative expenses (other) incurred2020-01-31$602,216
Total non interest bearing cash at end of year2020-01-31$621,794
Total non interest bearing cash at end of year2020-01-31$621,794
Total non interest bearing cash at beginning of year2020-01-31$375,194
Total non interest bearing cash at beginning of year2020-01-31$375,194
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-01-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-01-31No
Value of net income/loss2020-01-31$-152,574
Value of net income/loss2020-01-31$-152,574
Value of net assets at end of year (total assets less liabilities)2020-01-31$13,936,143
Value of net assets at end of year (total assets less liabilities)2020-01-31$13,936,143
Value of net assets at beginning of year (total assets less liabilities)2020-01-31$14,088,717
Value of net assets at beginning of year (total assets less liabilities)2020-01-31$14,088,717
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-01-31No
Were any leases to which the plan was party in default or uncollectible2020-01-31No
Were any leases to which the plan was party in default or uncollectible2020-01-31No
Investment advisory and management fees2020-01-31$55,881
Investment advisory and management fees2020-01-31$55,881
Income. Interest from US Government securities2020-01-31$205,122
Income. Interest from US Government securities2020-01-31$205,122
Income. Interest from corporate debt instruments2020-01-31$157,652
Income. Interest from corporate debt instruments2020-01-31$157,652
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-01-31$669,878
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-01-31$669,878
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-01-31$1,354,086
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-01-31$1,354,086
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-01-31$1,354,086
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-01-31$1,354,086
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-01-31$6,922
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-01-31$6,922
Expenses. Payments to insurance carriers foe the provision of benefits2020-01-31$3,215,039
Expenses. Payments to insurance carriers foe the provision of benefits2020-01-31$3,215,039
Asset value of US Government securities at end of year2020-01-31$7,841,840
Asset value of US Government securities at end of year2020-01-31$7,841,840
Asset value of US Government securities at beginning of year2020-01-31$6,278,882
Asset value of US Government securities at beginning of year2020-01-31$6,278,882
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-01-31Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-01-31Yes
Was there a failure to transmit to the plan any participant contributions2020-01-31No
Was there a failure to transmit to the plan any participant contributions2020-01-31No
Has the plan failed to provide any benefit when due under the plan2020-01-31No
Has the plan failed to provide any benefit when due under the plan2020-01-31No
Contributions received in cash from employer2020-01-31$5,356,209
Contributions received in cash from employer2020-01-31$5,356,209
Employer contributions (assets) at end of year2020-01-31$436,000
Employer contributions (assets) at end of year2020-01-31$436,000
Employer contributions (assets) at beginning of year2020-01-31$436,000
Employer contributions (assets) at beginning of year2020-01-31$436,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-01-31$2,074,187
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-01-31$2,074,187
Asset. Corporate debt instrument debt (other) at end of year2020-01-31$4,726,958
Asset. Corporate debt instrument debt (other) at end of year2020-01-31$4,726,958
Asset. Corporate debt instrument debt (other) at beginning of year2020-01-31$5,648,661
Asset. Corporate debt instrument debt (other) at beginning of year2020-01-31$5,648,661
Contract administrator fees2020-01-31$48,384
Contract administrator fees2020-01-31$48,384
Liabilities. Value of benefit claims payable at end of year2020-01-31$414,000
Liabilities. Value of benefit claims payable at end of year2020-01-31$414,000
Liabilities. Value of benefit claims payable at beginning of year2020-01-31$102,000
Liabilities. Value of benefit claims payable at beginning of year2020-01-31$102,000
Did the plan have assets held for investment2020-01-31Yes
Did the plan have assets held for investment2020-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-01-31No
Aggregate proceeds on sale of assets2020-01-31$8,962,907
Aggregate proceeds on sale of assets2020-01-31$8,962,907
Aggregate carrying amount (costs) on sale of assets2020-01-31$8,954,655
Aggregate carrying amount (costs) on sale of assets2020-01-31$8,954,655
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-01-31No
Opinion of an independent qualified public accountant for this plan2020-01-31Unqualified
Opinion of an independent qualified public accountant for this plan2020-01-31Unqualified
Accountancy firm name2020-01-31LINDQUIST LLP
Accountancy firm name2020-01-31LINDQUIST LLP
Accountancy firm EIN2020-01-31522385296
Accountancy firm EIN2020-01-31522385296
2019 : MFOW WELFARE FUND 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-01-31$-17,773
Total unrealized appreciation/depreciation of assets2019-01-31$-17,773
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-01-31$105,250
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-01-31$191,250
Total income from all sources (including contributions)2019-01-31$5,577,054
Total loss/gain on sale of assets2019-01-31$-29,352
Total of all expenses incurred2019-01-31$5,382,103
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-01-31$4,585,334
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-01-31$5,216,962
Value of total assets at end of year2019-01-31$14,193,967
Value of total assets at beginning of year2019-01-31$14,085,016
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-01-31$796,769
Total interest from all sources2019-01-31$340,010
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-01-31No
Administrative expenses professional fees incurred2019-01-31$144,098
Was this plan covered by a fidelity bond2019-01-31Yes
Value of fidelity bond cover2019-01-31$500,000
Were there any nonexempt tranactions with any party-in-interest2019-01-31No
Contributions received from participants2019-01-31$15,755
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-01-31$101,144
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-01-31$104,775
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-01-31$3,250
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-01-31$3,250
Other income not declared elsewhere2019-01-31$67,207
Administrative expenses (other) incurred2019-01-31$543,295
Total non interest bearing cash at end of year2019-01-31$375,194
Total non interest bearing cash at beginning of year2019-01-31$501,720
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-01-31No
Value of net income/loss2019-01-31$194,951
Value of net assets at end of year (total assets less liabilities)2019-01-31$14,088,717
Value of net assets at beginning of year (total assets less liabilities)2019-01-31$13,893,766
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-01-31No
Were any leases to which the plan was party in default or uncollectible2019-01-31No
Investment advisory and management fees2019-01-31$53,448
Income. Interest from US Government securities2019-01-31$150,534
Income. Interest from corporate debt instruments2019-01-31$183,175
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-01-31$1,354,086
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-01-31$1,302,804
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-01-31$1,302,804
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-01-31$6,301
Expenses. Payments to insurance carriers foe the provision of benefits2019-01-31$3,093,439
Asset value of US Government securities at end of year2019-01-31$6,278,882
Asset value of US Government securities at beginning of year2019-01-31$6,113,275
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-01-31Yes
Was there a failure to transmit to the plan any participant contributions2019-01-31No
Has the plan failed to provide any benefit when due under the plan2019-01-31No
Contributions received in cash from employer2019-01-31$5,201,207
Employer contributions (assets) at end of year2019-01-31$436,000
Employer contributions (assets) at beginning of year2019-01-31$401,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-01-31$1,491,895
Asset. Corporate debt instrument debt (other) at end of year2019-01-31$5,648,661
Asset. Corporate debt instrument debt (other) at beginning of year2019-01-31$5,661,442
Contract administrator fees2019-01-31$55,928
Liabilities. Value of benefit claims payable at end of year2019-01-31$102,000
Liabilities. Value of benefit claims payable at beginning of year2019-01-31$188,000
Did the plan have assets held for investment2019-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-01-31No
Aggregate proceeds on sale of assets2019-01-31$9,828,670
Aggregate carrying amount (costs) on sale of assets2019-01-31$9,858,022
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-01-31No
Opinion of an independent qualified public accountant for this plan2019-01-31Unqualified
Accountancy firm name2019-01-31LINDQUIST LLP
Accountancy firm EIN2019-01-31522385296
2018 : MFOW WELFARE FUND 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-01-31$-113,422
Total unrealized appreciation/depreciation of assets2018-01-31$-113,422
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-01-31$191,250
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-01-31$408,674
Total income from all sources (including contributions)2018-01-31$5,353,144
Total loss/gain on sale of assets2018-01-31$-77,463
Total of all expenses incurred2018-01-31$5,281,952
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-01-31$4,607,349
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-01-31$5,148,212
Value of total assets at end of year2018-01-31$14,085,016
Value of total assets at beginning of year2018-01-31$14,231,248
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-01-31$674,603
Total interest from all sources2018-01-31$318,791
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-01-31No
Administrative expenses professional fees incurred2018-01-31$121,000
Was this plan covered by a fidelity bond2018-01-31Yes
Value of fidelity bond cover2018-01-31$500,000
If this is an individual account plan, was there a blackout period2018-01-31No
Were there any nonexempt tranactions with any party-in-interest2018-01-31No
Contributions received from participants2018-01-31$5,460
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-01-31$104,775
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-01-31$110,032
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-01-31$3,250
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-01-31$3,674
Other income not declared elsewhere2018-01-31$77,026
Administrative expenses (other) incurred2018-01-31$459,528
Total non interest bearing cash at end of year2018-01-31$501,720
Total non interest bearing cash at beginning of year2018-01-31$169,648
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-01-31No
Value of net income/loss2018-01-31$71,192
Value of net assets at end of year (total assets less liabilities)2018-01-31$13,893,766
Value of net assets at beginning of year (total assets less liabilities)2018-01-31$13,822,574
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-01-31No
Were any leases to which the plan was party in default or uncollectible2018-01-31No
Investment advisory and management fees2018-01-31$54,008
Income. Interest from US Government securities2018-01-31$151,879
Income. Interest from corporate debt instruments2018-01-31$163,607
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-01-31$1,302,804
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-01-31$2,056,734
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-01-31$2,056,734
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-01-31$3,305
Expenses. Payments to insurance carriers foe the provision of benefits2018-01-31$2,890,258
Asset value of US Government securities at end of year2018-01-31$6,113,275
Asset value of US Government securities at beginning of year2018-01-31$6,665,703
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-01-31Yes
Was there a failure to transmit to the plan any participant contributions2018-01-31No
Has the plan failed to provide any benefit when due under the plan2018-01-31No
Contributions received in cash from employer2018-01-31$5,142,752
Employer contributions (assets) at end of year2018-01-31$401,000
Employer contributions (assets) at beginning of year2018-01-31$409,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-01-31$1,717,091
Asset. Corporate debt instrument debt (other) at end of year2018-01-31$5,661,442
Asset. Corporate debt instrument debt (other) at beginning of year2018-01-31$4,820,131
Contract administrator fees2018-01-31$40,067
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-01-31No
Liabilities. Value of benefit claims payable at end of year2018-01-31$188,000
Liabilities. Value of benefit claims payable at beginning of year2018-01-31$405,000
Did the plan have assets held for investment2018-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-01-31No
Aggregate proceeds on sale of assets2018-01-31$10,706,686
Aggregate carrying amount (costs) on sale of assets2018-01-31$10,784,149
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-01-31No
Opinion of an independent qualified public accountant for this plan2018-01-31Unqualified
Accountancy firm name2018-01-31LINDQUIST LLP
Accountancy firm EIN2018-01-31522385296
2017 : MFOW WELFARE FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-01-31$-92,736
Total unrealized appreciation/depreciation of assets2017-01-31$-92,736
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-01-31$408,674
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-01-31$97,674
Total income from all sources (including contributions)2017-01-31$5,425,337
Total loss/gain on sale of assets2017-01-31$-21,661
Total of all expenses incurred2017-01-31$5,740,024
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-01-31$4,939,879
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-01-31$5,123,607
Value of total assets at end of year2017-01-31$14,231,248
Value of total assets at beginning of year2017-01-31$14,234,935
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-01-31$800,145
Total interest from all sources2017-01-31$320,460
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-01-31No
Administrative expenses professional fees incurred2017-01-31$142,721
Was this plan covered by a fidelity bond2017-01-31Yes
Value of fidelity bond cover2017-01-31$500,000
If this is an individual account plan, was there a blackout period2017-01-31No
Were there any nonexempt tranactions with any party-in-interest2017-01-31No
Contributions received from participants2017-01-31$16,264
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-01-31$110,032
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-01-31$120,877
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-01-31$3,674
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-01-31$3,674
Other income not declared elsewhere2017-01-31$95,667
Administrative expenses (other) incurred2017-01-31$546,385
Total non interest bearing cash at end of year2017-01-31$169,648
Total non interest bearing cash at beginning of year2017-01-31$316,327
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-01-31No
Value of net income/loss2017-01-31$-314,687
Value of net assets at end of year (total assets less liabilities)2017-01-31$13,822,574
Value of net assets at beginning of year (total assets less liabilities)2017-01-31$14,137,261
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-01-31No
Were any leases to which the plan was party in default or uncollectible2017-01-31No
Investment advisory and management fees2017-01-31$70,306
Income. Interest from US Government securities2017-01-31$143,111
Income. Interest from corporate debt instruments2017-01-31$175,812
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-01-31$2,056,734
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-01-31$2,000,741
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-01-31$2,000,741
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-01-31$1,537
Expenses. Payments to insurance carriers foe the provision of benefits2017-01-31$2,756,266
Asset value of US Government securities at end of year2017-01-31$6,665,703
Asset value of US Government securities at beginning of year2017-01-31$5,156,280
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-01-31Yes
Was there a failure to transmit to the plan any participant contributions2017-01-31No
Has the plan failed to provide any benefit when due under the plan2017-01-31No
Contributions received in cash from employer2017-01-31$5,107,343
Employer contributions (assets) at end of year2017-01-31$409,000
Employer contributions (assets) at beginning of year2017-01-31$365,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-01-31$2,183,613
Asset. Corporate debt instrument debt (other) at end of year2017-01-31$4,820,131
Asset. Corporate debt instrument debt (other) at beginning of year2017-01-31$6,275,710
Contract administrator fees2017-01-31$40,733
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-01-31No
Liabilities. Value of benefit claims payable at end of year2017-01-31$405,000
Liabilities. Value of benefit claims payable at beginning of year2017-01-31$94,000
Did the plan have assets held for investment2017-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-01-31No
Aggregate proceeds on sale of assets2017-01-31$9,657,786
Aggregate carrying amount (costs) on sale of assets2017-01-31$9,679,447
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-01-31No
Opinion of an independent qualified public accountant for this plan2017-01-31Unqualified
Accountancy firm name2017-01-31LINDQUIST LLP
Accountancy firm EIN2017-01-31522385296
2016 : MFOW WELFARE FUND 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-01-31$-160,770
Total unrealized appreciation/depreciation of assets2016-01-31$-160,770
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-01-31$97,674
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-01-31$171,102
Total income from all sources (including contributions)2016-01-31$5,062,920
Total loss/gain on sale of assets2016-01-31$-50,957
Total of all expenses incurred2016-01-31$4,984,349
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-01-31$4,300,747
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-01-31$4,869,593
Value of total assets at end of year2016-01-31$14,234,935
Value of total assets at beginning of year2016-01-31$14,229,792
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-01-31$683,602
Total interest from all sources2016-01-31$315,602
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-01-31No
Administrative expenses professional fees incurred2016-01-31$95,189
Was this plan covered by a fidelity bond2016-01-31Yes
Value of fidelity bond cover2016-01-31$500,000
If this is an individual account plan, was there a blackout period2016-01-31No
Were there any nonexempt tranactions with any party-in-interest2016-01-31No
Contributions received from participants2016-01-31$16,205
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-01-31$120,877
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-01-31$126,667
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-01-31$3,674
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-01-31$4,102
Other income not declared elsewhere2016-01-31$89,452
Administrative expenses (other) incurred2016-01-31$502,811
Total non interest bearing cash at end of year2016-01-31$316,327
Total non interest bearing cash at beginning of year2016-01-31$401,335
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-01-31No
Value of net income/loss2016-01-31$78,571
Value of net assets at end of year (total assets less liabilities)2016-01-31$14,137,261
Value of net assets at beginning of year (total assets less liabilities)2016-01-31$14,058,690
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-01-31No
Were any leases to which the plan was party in default or uncollectible2016-01-31No
Investment advisory and management fees2016-01-31$31,261
Income. Interest from US Government securities2016-01-31$119,905
Income. Interest from corporate debt instruments2016-01-31$195,080
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-01-31$2,000,741
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-01-31$1,853,501
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-01-31$1,853,501
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-01-31$617
Expenses. Payments to insurance carriers foe the provision of benefits2016-01-31$2,601,987
Asset value of US Government securities at end of year2016-01-31$5,156,280
Asset value of US Government securities at beginning of year2016-01-31$4,846,151
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-01-31Yes
Was there a failure to transmit to the plan any participant contributions2016-01-31No
Has the plan failed to provide any benefit when due under the plan2016-01-31No
Contributions received in cash from employer2016-01-31$4,853,388
Employer contributions (assets) at end of year2016-01-31$365,000
Employer contributions (assets) at beginning of year2016-01-31$404,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-01-31$1,698,760
Asset. Corporate debt instrument debt (other) at end of year2016-01-31$6,275,710
Asset. Corporate debt instrument debt (other) at beginning of year2016-01-31$6,598,138
Contract administrator fees2016-01-31$54,341
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-01-31No
Liabilities. Value of benefit claims payable at end of year2016-01-31$94,000
Liabilities. Value of benefit claims payable at beginning of year2016-01-31$167,000
Did the plan have assets held for investment2016-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-01-31No
Aggregate proceeds on sale of assets2016-01-31$9,030,383
Aggregate carrying amount (costs) on sale of assets2016-01-31$9,081,340
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-01-31No
Opinion of an independent qualified public accountant for this plan2016-01-31Unqualified
Accountancy firm name2016-01-31LINDQUIST LLP
Accountancy firm EIN2016-01-31522385296
2015 : MFOW WELFARE FUND 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-01-31$-66,662
Total unrealized appreciation/depreciation of assets2015-01-31$-66,662
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-01-31$171,102
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-01-31$573,177
Total income from all sources (including contributions)2015-01-31$4,798,205
Total loss/gain on sale of assets2015-01-31$-58,708
Total of all expenses incurred2015-01-31$4,476,989
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-01-31$3,785,447
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-01-31$4,491,496
Value of total assets at end of year2015-01-31$14,229,792
Value of total assets at beginning of year2015-01-31$14,310,651
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-01-31$691,542
Total interest from all sources2015-01-31$336,009
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-01-31No
Administrative expenses professional fees incurred2015-01-31$90,454
Was this plan covered by a fidelity bond2015-01-31Yes
Value of fidelity bond cover2015-01-31$500,000
If this is an individual account plan, was there a blackout period2015-01-31No
Were there any nonexempt tranactions with any party-in-interest2015-01-31No
Contributions received from participants2015-01-31$12,367
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-01-31$126,667
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-01-31$176,878
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-01-31$4,102
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-01-31$493,177
Other income not declared elsewhere2015-01-31$96,070
Administrative expenses (other) incurred2015-01-31$498,581
Total non interest bearing cash at end of year2015-01-31$401,335
Total non interest bearing cash at beginning of year2015-01-31$349,461
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-01-31No
Value of net income/loss2015-01-31$321,216
Value of net assets at end of year (total assets less liabilities)2015-01-31$14,058,690
Value of net assets at beginning of year (total assets less liabilities)2015-01-31$13,737,474
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-01-31No
Were any leases to which the plan was party in default or uncollectible2015-01-31No
Investment advisory and management fees2015-01-31$47,357
Income. Interest from US Government securities2015-01-31$129,150
Income. Interest from corporate debt instruments2015-01-31$206,413
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-01-31$1,853,501
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-01-31$2,281,202
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-01-31$2,281,202
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-01-31$446
Expenses. Payments to insurance carriers foe the provision of benefits2015-01-31$2,319,770
Asset value of US Government securities at end of year2015-01-31$4,846,151
Asset value of US Government securities at beginning of year2015-01-31$5,145,756
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-01-31Yes
Was there a failure to transmit to the plan any participant contributions2015-01-31No
Has the plan failed to provide any benefit when due under the plan2015-01-31No
Contributions received in cash from employer2015-01-31$4,479,129
Employer contributions (assets) at end of year2015-01-31$404,000
Employer contributions (assets) at beginning of year2015-01-31$290,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-01-31$1,465,677
Asset. Corporate debt instrument debt (other) at end of year2015-01-31$6,598,138
Asset. Corporate debt instrument debt (other) at beginning of year2015-01-31$6,067,354
Contract administrator fees2015-01-31$55,150
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-01-31No
Liabilities. Value of benefit claims payable at end of year2015-01-31$167,000
Liabilities. Value of benefit claims payable at beginning of year2015-01-31$80,000
Did the plan have assets held for investment2015-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-01-31No
Aggregate proceeds on sale of assets2015-01-31$7,846,441
Aggregate carrying amount (costs) on sale of assets2015-01-31$7,905,149
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-01-31No
Opinion of an independent qualified public accountant for this plan2015-01-31Unqualified
Accountancy firm name2015-01-31LINDQUIST LLP
Accountancy firm EIN2015-01-31522385296
2014 : MFOW WELFARE FUND 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-01-31$-98,431
Total unrealized appreciation/depreciation of assets2014-01-31$-98,431
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-01-31$573,177
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-01-31$290,987
Total income from all sources (including contributions)2014-01-31$4,231,146
Total loss/gain on sale of assets2014-01-31$-131,944
Total of all expenses incurred2014-01-31$4,667,038
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-01-31$3,988,461
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-01-31$3,915,925
Value of total assets at end of year2014-01-31$14,310,651
Value of total assets at beginning of year2014-01-31$14,464,353
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-01-31$678,577
Total interest from all sources2014-01-31$400,315
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-01-31No
Administrative expenses professional fees incurred2014-01-31$96,056
Was this plan covered by a fidelity bond2014-01-31Yes
Value of fidelity bond cover2014-01-31$500,000
If this is an individual account plan, was there a blackout period2014-01-31No
Were there any nonexempt tranactions with any party-in-interest2014-01-31No
Contributions received from participants2014-01-31$13,798
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-01-31$176,878
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-01-31$225,478
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-01-31$493,177
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-01-31$137,987
Other income not declared elsewhere2014-01-31$145,281
Administrative expenses (other) incurred2014-01-31$488,988
Total non interest bearing cash at end of year2014-01-31$349,461
Total non interest bearing cash at beginning of year2014-01-31$233,118
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-01-31No
Value of net income/loss2014-01-31$-435,892
Value of net assets at end of year (total assets less liabilities)2014-01-31$13,737,474
Value of net assets at beginning of year (total assets less liabilities)2014-01-31$14,173,366
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-01-31No
Were any leases to which the plan was party in default or uncollectible2014-01-31No
Investment advisory and management fees2014-01-31$58,347
Income. Interest from US Government securities2014-01-31$160,804
Income. Interest from corporate debt instruments2014-01-31$238,644
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-01-31$2,281,202
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-01-31$2,298,326
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-01-31$2,298,326
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-01-31$867
Expenses. Payments to insurance carriers foe the provision of benefits2014-01-31$2,257,514
Asset value of US Government securities at end of year2014-01-31$5,145,756
Asset value of US Government securities at beginning of year2014-01-31$5,783,541
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-01-31Yes
Was there a failure to transmit to the plan any participant contributions2014-01-31No
Has the plan failed to provide any benefit when due under the plan2014-01-31No
Contributions received in cash from employer2014-01-31$3,902,127
Employer contributions (assets) at end of year2014-01-31$290,000
Employer contributions (assets) at beginning of year2014-01-31$347,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-01-31$1,730,947
Asset. Corporate debt instrument debt (other) at end of year2014-01-31$6,067,354
Asset. Corporate debt instrument debt (other) at beginning of year2014-01-31$5,576,890
Contract administrator fees2014-01-31$35,186
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-01-31No
Liabilities. Value of benefit claims payable at end of year2014-01-31$80,000
Liabilities. Value of benefit claims payable at beginning of year2014-01-31$153,000
Did the plan have assets held for investment2014-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-01-31No
Aggregate proceeds on sale of assets2014-01-31$9,680,133
Aggregate carrying amount (costs) on sale of assets2014-01-31$9,812,077
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-01-31No
Opinion of an independent qualified public accountant for this plan2014-01-31Unqualified
Accountancy firm name2014-01-31LINDQUIST LLP
Accountancy firm EIN2014-01-31522385296
2013 : MFOW WELFARE FUND 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-01-31$-48,428
Total unrealized appreciation/depreciation of assets2013-01-31$-48,428
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-01-31$290,987
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-01-31$276,090
Total income from all sources (including contributions)2013-01-31$4,738,853
Total loss/gain on sale of assets2013-01-31$-111,230
Total of all expenses incurred2013-01-31$4,312,543
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-01-31$3,664,249
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-01-31$4,100,768
Value of total assets at end of year2013-01-31$14,464,353
Value of total assets at beginning of year2013-01-31$14,023,146
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-01-31$648,294
Total interest from all sources2013-01-31$450,228
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-01-31No
Administrative expenses professional fees incurred2013-01-31$88,897
Was this plan covered by a fidelity bond2013-01-31Yes
Value of fidelity bond cover2013-01-31$500,000
If this is an individual account plan, was there a blackout period2013-01-31No
Were there any nonexempt tranactions with any party-in-interest2013-01-31No
Contributions received from participants2013-01-31$6,598
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-01-31$225,478
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-01-31$192,454
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-01-31$137,987
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-01-31$135,090
Other income not declared elsewhere2013-01-31$347,515
Administrative expenses (other) incurred2013-01-31$461,225
Total non interest bearing cash at end of year2013-01-31$233,118
Total non interest bearing cash at beginning of year2013-01-31$274,861
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-01-31No
Value of net income/loss2013-01-31$426,310
Value of net assets at end of year (total assets less liabilities)2013-01-31$14,173,366
Value of net assets at beginning of year (total assets less liabilities)2013-01-31$13,747,056
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-01-31No
Were any leases to which the plan was party in default or uncollectible2013-01-31No
Investment advisory and management fees2013-01-31$68,172
Income. Interest from US Government securities2013-01-31$217,948
Income. Interest from corporate debt instruments2013-01-31$229,812
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-01-31$2,298,326
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-01-31$2,208,219
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-01-31$2,208,219
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-01-31$2,468
Expenses. Payments to insurance carriers foe the provision of benefits2013-01-31$1,986,303
Asset value of US Government securities at end of year2013-01-31$5,783,541
Asset value of US Government securities at beginning of year2013-01-31$6,284,183
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-01-31Yes
Was there a failure to transmit to the plan any participant contributions2013-01-31No
Has the plan failed to provide any benefit when due under the plan2013-01-31No
Contributions received in cash from employer2013-01-31$4,094,170
Employer contributions (assets) at end of year2013-01-31$347,000
Employer contributions (assets) at beginning of year2013-01-31$362,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-01-31$1,677,946
Asset. Corporate debt instrument debt (other) at end of year2013-01-31$5,576,890
Asset. Corporate debt instrument debt (other) at beginning of year2013-01-31$4,701,429
Contract administrator fees2013-01-31$30,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-01-31No
Liabilities. Value of benefit claims payable at end of year2013-01-31$153,000
Liabilities. Value of benefit claims payable at beginning of year2013-01-31$141,000
Did the plan have assets held for investment2013-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-01-31No
Aggregate proceeds on sale of assets2013-01-31$8,717,033
Aggregate carrying amount (costs) on sale of assets2013-01-31$8,828,263
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-01-31No
Opinion of an independent qualified public accountant for this plan2013-01-31Unqualified
Accountancy firm name2013-01-31LINDQUIST LLP
Accountancy firm EIN2013-01-31522385296
2012 : MFOW WELFARE FUND 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-01-31$-17,521
Total unrealized appreciation/depreciation of assets2012-01-31$-17,521
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-01-31$276,090
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-01-31$342,513
Total income from all sources (including contributions)2012-01-31$4,624,271
Total loss/gain on sale of assets2012-01-31$-130,798
Total of all expenses incurred2012-01-31$3,953,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-01-31$3,331,314
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-01-31$4,032,069
Value of total assets at end of year2012-01-31$14,023,146
Value of total assets at beginning of year2012-01-31$13,418,684
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-01-31$622,072
Total interest from all sources2012-01-31$454,246
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-01-31No
Administrative expenses professional fees incurred2012-01-31$111,050
Was this plan covered by a fidelity bond2012-01-31Yes
Value of fidelity bond cover2012-01-31$500,000
If this is an individual account plan, was there a blackout period2012-01-31No
Were there any nonexempt tranactions with any party-in-interest2012-01-31No
Contributions received from participants2012-01-31$2,212
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-01-31$192,454
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-01-31$273,367
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-01-31$135,090
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-01-31$175,677
Other income not declared elsewhere2012-01-31$286,275
Administrative expenses (other) incurred2012-01-31$427,685
Liabilities. Value of operating payables at end of year2012-01-31$0
Liabilities. Value of operating payables at beginning of year2012-01-31$836
Total non interest bearing cash at end of year2012-01-31$274,861
Total non interest bearing cash at beginning of year2012-01-31$307,459
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-01-31No
Value of net income/loss2012-01-31$670,885
Value of net assets at end of year (total assets less liabilities)2012-01-31$13,747,056
Value of net assets at beginning of year (total assets less liabilities)2012-01-31$13,076,171
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-01-31No
Were any leases to which the plan was party in default or uncollectible2012-01-31No
Investment advisory and management fees2012-01-31$53,337
Income. Interest from US Government securities2012-01-31$226,710
Income. Interest from corporate debt instruments2012-01-31$224,720
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-01-31$2,208,219
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-01-31$1,930,915
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-01-31$1,930,915
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-01-31$2,816
Expenses. Payments to insurance carriers foe the provision of benefits2012-01-31$1,804,323
Asset value of US Government securities at end of year2012-01-31$6,284,183
Asset value of US Government securities at beginning of year2012-01-31$5,827,598
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-01-31Yes
Was there a failure to transmit to the plan any participant contributions2012-01-31No
Has the plan failed to provide any benefit when due under the plan2012-01-31No
Contributions received in cash from employer2012-01-31$4,029,857
Employer contributions (assets) at end of year2012-01-31$362,000
Employer contributions (assets) at beginning of year2012-01-31$332,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-01-31$1,526,991
Asset. Corporate debt instrument debt (other) at end of year2012-01-31$4,701,429
Asset. Corporate debt instrument debt (other) at beginning of year2012-01-31$4,747,345
Contract administrator fees2012-01-31$30,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-01-31No
Liabilities. Value of benefit claims payable at end of year2012-01-31$141,000
Liabilities. Value of benefit claims payable at beginning of year2012-01-31$166,000
Did the plan have assets held for investment2012-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-01-31No
Aggregate proceeds on sale of assets2012-01-31$14,256,130
Aggregate carrying amount (costs) on sale of assets2012-01-31$14,386,928
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-01-31No
Opinion of an independent qualified public accountant for this plan2012-01-31Unqualified
Accountancy firm name2012-01-31LINDQUIST LLP
Accountancy firm EIN2012-01-31522385296
2011 : MFOW WELFARE FUND 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-01-31$-4,530
Total unrealized appreciation/depreciation of assets2011-01-31$-4,530
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-01-31$342,513
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-01-31$114,000
Total income from all sources (including contributions)2011-01-31$4,326,647
Total loss/gain on sale of assets2011-01-31$-113,918
Total of all expenses incurred2011-01-31$3,785,752
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-01-31$3,161,396
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-01-31$3,770,150
Value of total assets at end of year2011-01-31$13,418,684
Value of total assets at beginning of year2011-01-31$12,649,276
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-01-31$624,356
Total interest from all sources2011-01-31$472,919
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-01-31No
Administrative expenses professional fees incurred2011-01-31$106,501
Was this plan covered by a fidelity bond2011-01-31Yes
Value of fidelity bond cover2011-01-31$500,000
If this is an individual account plan, was there a blackout period2011-01-31No
Were there any nonexempt tranactions with any party-in-interest2011-01-31No
Contributions received from participants2011-01-31$12,918
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-01-31$273,367
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-01-31$227,337
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-01-31$175,677
Other income not declared elsewhere2011-01-31$202,026
Administrative expenses (other) incurred2011-01-31$422,670
Liabilities. Value of operating payables at end of year2011-01-31$836
Total non interest bearing cash at end of year2011-01-31$307,459
Total non interest bearing cash at beginning of year2011-01-31$182,430
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-01-31No
Value of net income/loss2011-01-31$540,895
Value of net assets at end of year (total assets less liabilities)2011-01-31$13,076,171
Value of net assets at beginning of year (total assets less liabilities)2011-01-31$12,535,276
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-01-31No
Were any leases to which the plan was party in default or uncollectible2011-01-31No
Investment advisory and management fees2011-01-31$67,685
Income. Interest from US Government securities2011-01-31$236,218
Income. Interest from corporate debt instruments2011-01-31$232,952
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-01-31$1,930,915
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-01-31$1,653,965
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-01-31$1,653,965
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-01-31$3,749
Expenses. Payments to insurance carriers foe the provision of benefits2011-01-31$1,610,351
Asset value of US Government securities at end of year2011-01-31$5,827,598
Asset value of US Government securities at beginning of year2011-01-31$5,706,853
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-01-31Yes
Was there a failure to transmit to the plan any participant contributions2011-01-31No
Has the plan failed to provide any benefit when due under the plan2011-01-31No
Contributions received in cash from employer2011-01-31$3,757,232
Employer contributions (assets) at end of year2011-01-31$332,000
Employer contributions (assets) at beginning of year2011-01-31$285,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-01-31$1,551,045
Asset. Corporate debt instrument debt (other) at end of year2011-01-31$4,747,345
Asset. Corporate debt instrument debt (other) at beginning of year2011-01-31$4,593,691
Contract administrator fees2011-01-31$27,500
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-01-31No
Liabilities. Value of benefit claims payable at end of year2011-01-31$166,000
Liabilities. Value of benefit claims payable at beginning of year2011-01-31$114,000
Did the plan have assets held for investment2011-01-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-01-31No
Aggregate proceeds on sale of assets2011-01-31$11,012,704
Aggregate carrying amount (costs) on sale of assets2011-01-31$11,126,622
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-01-31No
Opinion of an independent qualified public accountant for this plan2011-01-31Unqualified
Accountancy firm name2011-01-31LINDQUIST LLP
Accountancy firm EIN2011-01-31522385296

Form 5500 Responses for MFOW WELFARE FUND

2022: MFOW WELFARE FUND 2022 form 5500 responses
2022-02-01Type of plan entityMulti-employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planYes
2022-02-01Plan funding arrangement – TrustYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement - TrustYes
2021: MFOW WELFARE FUND 2021 form 5500 responses
2021-02-01Type of plan entityMulti-employer plan
2021-02-01Submission has been amendedNo
2021-02-01This submission is the final filingNo
2021-02-01This return/report is a short plan year return/report (less than 12 months)No
2021-02-01Plan is a collectively bargained planYes
2021-02-01Plan funding arrangement – TrustYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement - TrustYes
2020: MFOW WELFARE FUND 2020 form 5500 responses
2020-02-01Type of plan entityMulti-employer plan
2020-02-01Plan is a collectively bargained planYes
2020-02-01Plan funding arrangement – TrustYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement - TrustYes
2019: MFOW WELFARE FUND 2019 form 5500 responses
2019-02-01Type of plan entityMulti-employer plan
2019-02-01Plan is a collectively bargained planYes
2019-02-01Plan funding arrangement – TrustYes
2019-02-01Plan benefit arrangement – InsuranceYes
2019-02-01Plan benefit arrangement - TrustYes
2018: MFOW WELFARE FUND 2018 form 5500 responses
2018-02-01Type of plan entityMulti-employer plan
2018-02-01Plan is a collectively bargained planYes
2018-02-01Plan funding arrangement – TrustYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement - TrustYes
2017: MFOW WELFARE FUND 2017 form 5500 responses
2017-02-01Type of plan entityMulti-employer plan
2017-02-01Plan is a collectively bargained planYes
2017-02-01Plan funding arrangement – TrustYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement - TrustYes
2016: MFOW WELFARE FUND 2016 form 5500 responses
2016-02-01Type of plan entityMulti-employer plan
2016-02-01Plan is a collectively bargained planYes
2016-02-01Plan funding arrangement – TrustYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement - TrustYes
2015: MFOW WELFARE FUND 2015 form 5500 responses
2015-02-01Type of plan entityMulti-employer plan
2015-02-01Plan is a collectively bargained planYes
2015-02-01Plan funding arrangement – TrustYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement - TrustYes
2014: MFOW WELFARE FUND 2014 form 5500 responses
2014-02-01Type of plan entityMulti-employer plan
2014-02-01Plan is a collectively bargained planYes
2014-02-01Plan funding arrangement – TrustYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement - TrustYes
2013: MFOW WELFARE FUND 2013 form 5500 responses
2013-02-01Type of plan entityMulti-employer plan
2013-02-01Plan is a collectively bargained planYes
2013-02-01Plan funding arrangement – TrustYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement - TrustYes
2012: MFOW WELFARE FUND 2012 form 5500 responses
2012-02-01Type of plan entityMulti-employer plan
2012-02-01Plan is a collectively bargained planYes
2012-02-01Plan funding arrangement – TrustYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement - TrustYes
2011: MFOW WELFARE FUND 2011 form 5500 responses
2011-02-01Type of plan entityMulti-employer plan
2011-02-01Plan is a collectively bargained planYes
2011-02-01Plan funding arrangement – TrustYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement - TrustYes
2010: MFOW WELFARE FUND 2010 form 5500 responses
2010-02-01Type of plan entityMulti-employer plan
2010-02-01Plan is a collectively bargained planYes
2010-02-01Plan funding arrangement – TrustYes
2010-02-01Plan benefit arrangement – InsuranceYes
2010-02-01Plan benefit arrangement - TrustYes
2009: MFOW WELFARE FUND 2009 form 5500 responses
2009-02-01Type of plan entityMulti-employer plan
2009-02-01Submission has been amendedYes
2009-02-01This submission is the final filingNo
2009-02-01Plan is a collectively bargained planYes
2009-02-01Plan funding arrangement – TrustYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number20506
Policy instance 3
Insurance contract or identification number20506
Number of Individuals Covered213
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $466,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282458
Policy instance 1
Insurance contract or identification number282458
Number of Individuals Covered361
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $145,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282458
Policy instance 2
Insurance contract or identification number282458
Number of Individuals Covered367
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $21,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 10
Insurance contract or identification number711949
Number of Individuals Covered194
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $70,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 4
Insurance contract or identification numberW1034
Number of Individuals Covered38
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A, 57953A,
Policy instance 5
Insurance contract or identification numberN4367A, 57953A,
Number of Individuals Covered29
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $533,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 6
Insurance contract or identification number2311
Number of Individuals Covered58
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $398,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered10
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $105,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 8
Insurance contract or identification number0156000
Number of Individuals Covered36
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $412,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 9
Insurance contract or identification number102126-0000
Number of Individuals Covered163
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,297,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282458
Policy instance 1
Insurance contract or identification number282458
Number of Individuals Covered349
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $144,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282458
Policy instance 2
Insurance contract or identification number282458
Number of Individuals Covered198
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $414,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 3
Insurance contract or identification numberW1034
Number of Individuals Covered37
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A, 57953A,
Policy instance 4
Insurance contract or identification numberN4367A, 57953A,
Number of Individuals Covered30
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $441,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 5
Insurance contract or identification number2311
Number of Individuals Covered56
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $305,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 7
Insurance contract or identification number0156000
Number of Individuals Covered38
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $230,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 8
Insurance contract or identification number102126-0000
Number of Individuals Covered154
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,263,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 9
Insurance contract or identification number1178301
Number of Individuals Covered400
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $220,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 10
Insurance contract or identification number711949
Number of Individuals Covered184
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $67,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 6
Insurance contract or identification number1817
Number of Individuals Covered10
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $111,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered9
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered50
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered42
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered398
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $81,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered39
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $294,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A,
Policy instance 5
Insurance contract or identification numberN4367A,57953A,
Number of Individuals Covered33
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $513,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 6
Insurance contract or identification number102126-0000
Number of Individuals Covered155
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,307,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 8
Insurance contract or identification number711949
Number of Individuals Covered184
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282458
Policy instance 9
Insurance contract or identification number282458
Number of Individuals Covered971
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $373,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282458
Policy instance 10
Insurance contract or identification number282458
Number of Individuals Covered323
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $150,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595, 282458
Policy instance 9
Insurance contract or identification number276595, 282458
Number of Individuals Covered389
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $359,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 8
Insurance contract or identification number711949
Number of Individuals Covered202
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered10
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered33
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $525,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 6
Insurance contract or identification number102126-0000
Number of Individuals Covered178
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,210,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered42
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $286,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered51
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $315,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered43
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered419
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $82,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595, 282458
Policy instance 10
Insurance contract or identification number276595, 282458
Number of Individuals Covered342
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $177,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered438
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $85,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 10
Insurance contract or identification number276595
Number of Individuals Covered360
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $154,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 9
Insurance contract or identification number276595
Number of Individuals Covered383
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $311,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 8
Insurance contract or identification number711949
Number of Individuals Covered393
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered7
Insurance policy start date2018-01-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $43,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 6
Insurance contract or identification number102126-0000
Number of Individuals Covered162
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,146,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered38
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $602,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered43
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $265,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered51
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $322,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered40
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered39
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered44
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $238,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered43
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered47
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $629,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 6
Insurance contract or identification number102126-0000
Number of Individuals Covered158
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,071,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered9
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $76,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 8
Insurance contract or identification number711949
Number of Individuals Covered210
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 9
Insurance contract or identification number276595
Number of Individuals Covered390
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $268,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 10
Insurance contract or identification number276595
Number of Individuals Covered363
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $147,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered450
Insurance policy start date2016-11-01
Insurance policy end date2017-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $82,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered6
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $56,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 10
Insurance contract or identification number276595
Number of Individuals Covered390
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $185,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 9
Insurance contract or identification number276595
Number of Individuals Covered442
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $220,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 8
Insurance contract or identification number711949
Number of Individuals Covered194
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 6
Insurance contract or identification number102126-0000
Number of Individuals Covered139
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $829,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered456
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $77,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered51
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $553,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered48
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $257,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered35
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $218,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered46
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 6
Insurance contract or identification number102126-0000
Number of Individuals Covered115
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $734,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 7
Insurance contract or identification number1817
Number of Individuals Covered8
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $61,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 8
Insurance contract or identification number711949
Number of Individuals Covered168
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 9
Insurance contract or identification number276595
Number of Individuals Covered381
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $187,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered45
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $536,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered46
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $226,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered34
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $176,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 10
Insurance contract or identification number276595
Number of Individuals Covered425
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $208,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered440
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $71,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered45
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 11
Insurance contract or identification number276595
Number of Individuals Covered406
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $95,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered42
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered32
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $157,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered41
Insurance policy start date2013-02-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $209,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered50
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $549,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 7
Insurance contract or identification number102126-0000
Number of Individuals Covered114
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $756,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 8
Insurance contract or identification number1817
Number of Individuals Covered9
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $66,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 9
Insurance contract or identification number711949
Number of Individuals Covered171
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276595
Policy instance 10
Insurance contract or identification number276595
Number of Individuals Covered373
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered439
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $75,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010074-000
Policy instance 6
Insurance contract or identification number16-010074-000
Number of Individuals Covered393
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $154,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered492
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $80,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered45
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311
Policy instance 3
Insurance contract or identification number2311
Number of Individuals Covered129
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $149,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered42
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $223,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered57
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $515,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010074-000
Policy instance 6
Insurance contract or identification number16-010074-000
Number of Individuals Covered337
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $75,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number102126-0000
Policy instance 7
Insurance contract or identification number102126-0000
Number of Individuals Covered33
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $744,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 9
Insurance contract or identification number711949
Number of Individuals Covered183
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 8
Insurance contract or identification number1817
Number of Individuals Covered9
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $63,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered53
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $414,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311/10
Policy instance 3
Insurance contract or identification number2311/10
Number of Individuals Covered33
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $146,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 10
Insurance contract or identification number711949
Number of Individuals Covered176
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 9
Insurance contract or identification number1817
Number of Individuals Covered9
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $56,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number4549
Policy instance 8
Insurance contract or identification number4549
Number of Individuals Covered0
Insurance policy start date2011-02-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEAP PREMIUMS
Welfare Benefit Premiums Paid to CarrierUSD $256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 7
Insurance contract or identification number102126-0000
Number of Individuals Covered122
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $665,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberP80263-3
Policy instance 6
Insurance contract or identification numberP80263-3
Number of Individuals Covered203
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $111,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered41
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $187,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered39
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered501
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $89,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number4549
Policy instance 8
Insurance contract or identification number4549
Number of Individuals Covered250
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEAP PREMIUMS
Welfare Benefit Premiums Paid to CarrierUSD $2,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1178301
Policy instance 1
Insurance contract or identification number1178301
Number of Individuals Covered641
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $84,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAL HEALTH SERVICES OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47490 )
Policy contract numberW1034
Policy instance 2
Insurance contract or identification numberW1034
Number of Individuals Covered34
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number2311/10
Policy instance 3
Insurance contract or identification number2311/10
Number of Individuals Covered34
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $120,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0156000
Policy instance 4
Insurance contract or identification number0156000
Number of Individuals Covered36
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $182,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberP80263-3
Policy instance 6
Insurance contract or identification numberP80263-3
Number of Individuals Covered195
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $136,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberN4367A,57953A
Policy instance 5
Insurance contract or identification numberN4367A,57953A
Number of Individuals Covered48
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $384,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711949
Policy instance 10
Insurance contract or identification number711949
Number of Individuals Covered172
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number102126-0000
Policy instance 7
Insurance contract or identification number102126-0000
Number of Individuals Covered124
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $572,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1817
Policy instance 9
Insurance contract or identification number1817
Number of Individuals Covered7
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $56,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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