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| Plan Name | KAISER FOUNDATION HEALTH PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | THE REUTLINGER COMMUNITY |
| Employer identification number (EIN): | 943201366 |
| NAIC Classification: | 813000 |
| NAIC Description: | Religious, Grantmaking, Civic, Professional, and Similar Organizations |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2017-01-01 | BRIAN MORROW |
| Measure | Date | Value |
|---|---|---|
| 2017: KAISER FOUNDATION HEALTH PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 168 |
| Total of all active and inactive participants | 2017-01-01 | 168 |
| Total participants | 2017-01-01 | 168 |
| Measure | Date | Value |
|---|---|---|
| 2017 : KAISER FOUNDATION HEALTH PLAN 2017 401k financial data | ||
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $0 |
| Total income from all sources (including contributions) | 2017-12-31 | $1,174,825 |
| Total loss/gain on sale of assets | 2017-12-31 | $0 |
| Total of all expenses incurred | 2017-12-31 | $1,174,825 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $1,174,825 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $1,174,825 |
| Value of total assets at end of year | 2017-12-31 | $0 |
| Value of total assets at beginning of year | 2017-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $0 |
| Total interest from all sources | 2017-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $46,543 |
| Value of net income/loss | 2017-12-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $0 |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $1,174,825 |
| Contributions received in cash from employer | 2017-12-31 | $1,128,282 |
| 2017: KAISER FOUNDATION HEALTH PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 604778 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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