BOARD OF TRUSTEES PLUMBERS & STEAMFITTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN
401k plan membership statisitcs for PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2022 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $318,312 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $44,088 |
| Total income from all sources (including contributions) | 2022-06-30 | $5,975,143 |
| Total loss/gain on sale of assets | 2022-06-30 | $0 |
| Total of all expenses incurred | 2022-06-30 | $6,998,236 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-06-30 | $6,270,205 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-06-30 | $6,744,176 |
| Value of total assets at end of year | 2022-06-30 | $13,064,866 |
| Value of total assets at beginning of year | 2022-06-30 | $13,813,735 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-06-30 | $728,031 |
| Total interest from all sources | 2022-06-30 | $468 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-06-30 | $277,323 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-06-30 | $277,323 |
| Administrative expenses professional fees incurred | 2022-06-30 | $170,608 |
| Was this plan covered by a fidelity bond | 2022-06-30 | Yes |
| Value of fidelity bond cover | 2022-06-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-06-30 | No |
| Contributions received from participants | 2022-06-30 | $493,636 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-06-30 | $524,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-06-30 | $519,000 |
| Other income not declared elsewhere | 2022-06-30 | $143,558 |
| Administrative expenses (other) incurred | 2022-06-30 | $297,933 |
| Liabilities. Value of operating payables at end of year | 2022-06-30 | $318,312 |
| Liabilities. Value of operating payables at beginning of year | 2022-06-30 | $44,088 |
| Total non interest bearing cash at end of year | 2022-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2022-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Value of net income/loss | 2022-06-30 | $-1,023,093 |
| Value of net assets at end of year (total assets less liabilities) | 2022-06-30 | $12,746,554 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-06-30 | $13,769,647 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-06-30 | No |
| Investment advisory and management fees | 2022-06-30 | $2,205 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-06-30 | $11,254,526 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-06-30 | $12,167,584 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-06-30 | $813,132 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-06-30 | $574,943 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-06-30 | $574,943 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-06-30 | $468 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-06-30 | $6,169,675 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-06-30 | $-1,190,382 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-06-30 | No |
| Contributions received in cash from employer | 2022-06-30 | $6,250,540 |
| Employer contributions (assets) at end of year | 2022-06-30 | $468,000 |
| Employer contributions (assets) at beginning of year | 2022-06-30 | $547,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-06-30 | $100,530 |
| Contract administrator fees | 2022-06-30 | $257,285 |
| Did the plan have assets held for investment | 2022-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-06-30 | Unqualified |
| Accountancy firm name | 2022-06-30 | WITHUMSMITH+BROWN, PC |
| Accountancy firm EIN | 2022-06-30 | 222027092 |
| 2021 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $44,088 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $40,058 |
| Total income from all sources (including contributions) | 2021-06-30 | $7,875,382 |
| Total of all expenses incurred | 2021-06-30 | $7,137,982 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-06-30 | $6,702,277 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-06-30 | $7,037,616 |
| Value of total assets at end of year | 2021-06-30 | $13,813,735 |
| Value of total assets at beginning of year | 2021-06-30 | $13,072,305 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-06-30 | $435,705 |
| Total interest from all sources | 2021-06-30 | $354 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-06-30 | $235,919 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-06-30 | $235,919 |
| Administrative expenses professional fees incurred | 2021-06-30 | $160,202 |
| Was this plan covered by a fidelity bond | 2021-06-30 | Yes |
| Value of fidelity bond cover | 2021-06-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-06-30 | No |
| Contributions received from participants | 2021-06-30 | $525,772 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-06-30 | $519,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-06-30 | $576,000 |
| Administrative expenses (other) incurred | 2021-06-30 | $14,236 |
| Liabilities. Value of operating payables at end of year | 2021-06-30 | $44,088 |
| Liabilities. Value of operating payables at beginning of year | 2021-06-30 | $40,058 |
| Total non interest bearing cash at end of year | 2021-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2021-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Value of net income/loss | 2021-06-30 | $737,400 |
| Value of net assets at end of year (total assets less liabilities) | 2021-06-30 | $13,769,647 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-06-30 | $13,032,247 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-06-30 | No |
| Investment advisory and management fees | 2021-06-30 | $2,151 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-06-30 | $12,167,584 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-06-30 | $11,330,173 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-06-30 | $574,943 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-06-30 | $726,924 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-06-30 | $726,924 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-06-30 | $354 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-06-30 | $6,615,612 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-06-30 | $601,493 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-06-30 | No |
| Contributions received in cash from employer | 2021-06-30 | $6,511,844 |
| Employer contributions (assets) at end of year | 2021-06-30 | $547,000 |
| Employer contributions (assets) at beginning of year | 2021-06-30 | $434,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-06-30 | $86,665 |
| Contract administrator fees | 2021-06-30 | $259,116 |
| Did the plan have assets held for investment | 2021-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-06-30 | Unqualified |
| Accountancy firm name | 2021-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2021-06-30 | 522385296 |
| 2020 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $40,058 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $39,495 |
| Total income from all sources (including contributions) | 2020-06-30 | $7,947,914 |
| Total of all expenses incurred | 2020-06-30 | $7,169,116 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-06-30 | $6,744,511 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-06-30 | $7,264,501 |
| Value of total assets at end of year | 2020-06-30 | $13,072,305 |
| Value of total assets at beginning of year | 2020-06-30 | $12,292,944 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-06-30 | $424,605 |
| Total interest from all sources | 2020-06-30 | $966 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-06-30 | $258,901 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-06-30 | $258,901 |
| Administrative expenses professional fees incurred | 2020-06-30 | $151,845 |
| Was this plan covered by a fidelity bond | 2020-06-30 | Yes |
| Value of fidelity bond cover | 2020-06-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-06-30 | No |
| Contributions received from participants | 2020-06-30 | $439,485 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-06-30 | $576,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-06-30 | $524,000 |
| Administrative expenses (other) incurred | 2020-06-30 | $14,740 |
| Liabilities. Value of operating payables at end of year | 2020-06-30 | $40,058 |
| Liabilities. Value of operating payables at beginning of year | 2020-06-30 | $39,495 |
| Total non interest bearing cash at end of year | 2020-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2020-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Value of net income/loss | 2020-06-30 | $778,798 |
| Value of net assets at end of year (total assets less liabilities) | 2020-06-30 | $13,032,247 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-06-30 | $12,253,449 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-06-30 | No |
| Investment advisory and management fees | 2020-06-30 | $1,839 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-06-30 | $11,330,173 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-06-30 | $9,522,603 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-06-30 | $726,924 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-06-30 | $1,599,133 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-06-30 | $1,599,133 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-06-30 | $966 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-06-30 | $6,744,511 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-06-30 | $423,546 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-06-30 | No |
| Contributions received in cash from employer | 2020-06-30 | $6,825,016 |
| Employer contributions (assets) at end of year | 2020-06-30 | $434,000 |
| Employer contributions (assets) at beginning of year | 2020-06-30 | $642,000 |
| Contract administrator fees | 2020-06-30 | $256,181 |
| Did the plan have assets held for investment | 2020-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-06-30 | Unqualified |
| Accountancy firm name | 2020-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2020-06-30 | 522385296 |
| 2019 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $39,495 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $40,569 |
| Total income from all sources (including contributions) | 2019-06-30 | $9,224,582 |
| Total of all expenses incurred | 2019-06-30 | $6,741,019 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-06-30 | $6,320,309 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-06-30 | $8,653,749 |
| Value of total assets at end of year | 2019-06-30 | $12,292,944 |
| Value of total assets at beginning of year | 2019-06-30 | $9,810,455 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-06-30 | $420,710 |
| Total interest from all sources | 2019-06-30 | $960 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-06-30 | $247,519 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-06-30 | $247,519 |
| Administrative expenses professional fees incurred | 2019-06-30 | $133,962 |
| Was this plan covered by a fidelity bond | 2019-06-30 | Yes |
| Value of fidelity bond cover | 2019-06-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-06-30 | No |
| Contributions received from participants | 2019-06-30 | $449,118 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-06-30 | $524,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-06-30 | $462,000 |
| Administrative expenses (other) incurred | 2019-06-30 | $13,594 |
| Liabilities. Value of operating payables at end of year | 2019-06-30 | $39,495 |
| Liabilities. Value of operating payables at beginning of year | 2019-06-30 | $40,569 |
| Total non interest bearing cash at end of year | 2019-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2019-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Value of net income/loss | 2019-06-30 | $2,483,563 |
| Value of net assets at end of year (total assets less liabilities) | 2019-06-30 | $12,253,449 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-06-30 | $9,769,886 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-06-30 | No |
| Investment advisory and management fees | 2019-06-30 | $1,347 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-06-30 | $9,522,603 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-06-30 | $7,371,095 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-06-30 | $1,599,133 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-06-30 | $1,202,152 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-06-30 | $1,202,152 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-06-30 | $960 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-06-30 | $6,320,309 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-06-30 | $322,354 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-06-30 | No |
| Contributions received in cash from employer | 2019-06-30 | $8,204,631 |
| Employer contributions (assets) at end of year | 2019-06-30 | $642,000 |
| Employer contributions (assets) at beginning of year | 2019-06-30 | $770,000 |
| Contract administrator fees | 2019-06-30 | $271,807 |
| Did the plan have assets held for investment | 2019-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-06-30 | Unqualified |
| Accountancy firm name | 2019-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2019-06-30 | 522385296 |
| 2018 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $40,569 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $84,522 |
| Total income from all sources (including contributions) | 2018-06-30 | $7,472,392 |
| Total of all expenses incurred | 2018-06-30 | $5,484,121 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-06-30 | $5,100,680 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-06-30 | $7,342,759 |
| Value of total assets at end of year | 2018-06-30 | $9,810,455 |
| Value of total assets at beginning of year | 2018-06-30 | $7,866,137 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-06-30 | $383,441 |
| Total interest from all sources | 2018-06-30 | $904 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-06-30 | $153,809 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-06-30 | $153,809 |
| Administrative expenses professional fees incurred | 2018-06-30 | $138,859 |
| Was this plan covered by a fidelity bond | 2018-06-30 | Yes |
| Value of fidelity bond cover | 2018-06-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-06-30 | No |
| Contributions received from participants | 2018-06-30 | $447,829 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-06-30 | $462,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-06-30 | $377,000 |
| Administrative expenses (other) incurred | 2018-06-30 | $11,902 |
| Liabilities. Value of operating payables at end of year | 2018-06-30 | $40,569 |
| Liabilities. Value of operating payables at beginning of year | 2018-06-30 | $84,522 |
| Total non interest bearing cash at end of year | 2018-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2018-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Value of net income/loss | 2018-06-30 | $1,988,271 |
| Value of net assets at end of year (total assets less liabilities) | 2018-06-30 | $9,769,886 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-06-30 | $7,781,615 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-06-30 | No |
| Investment advisory and management fees | 2018-06-30 | $5,090 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-06-30 | $7,371,095 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-06-30 | $5,566,880 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-06-30 | $1,202,152 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-06-30 | $1,413,049 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-06-30 | $1,413,049 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-06-30 | $904 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-06-30 | $5,100,680 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-06-30 | $-25,080 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-06-30 | No |
| Contributions received in cash from employer | 2018-06-30 | $6,894,930 |
| Employer contributions (assets) at end of year | 2018-06-30 | $770,000 |
| Employer contributions (assets) at beginning of year | 2018-06-30 | $504,000 |
| Contract administrator fees | 2018-06-30 | $227,590 |
| Did the plan have assets held for investment | 2018-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-06-30 | Unqualified |
| Accountancy firm name | 2018-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2018-06-30 | 522385296 |
| 2017 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $84,522 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $70,916 |
| Total income from all sources (including contributions) | 2017-06-30 | $6,582,503 |
| Total of all expenses incurred | 2017-06-30 | $5,527,376 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-06-30 | $5,177,767 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-06-30 | $6,407,813 |
| Value of total assets at end of year | 2017-06-30 | $7,866,137 |
| Value of total assets at beginning of year | 2017-06-30 | $6,797,404 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-06-30 | $349,609 |
| Total interest from all sources | 2017-06-30 | $905 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-06-30 | $113,977 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-06-30 | $113,977 |
| Administrative expenses professional fees incurred | 2017-06-30 | $115,561 |
| Was this plan covered by a fidelity bond | 2017-06-30 | Yes |
| Value of fidelity bond cover | 2017-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-06-30 | No |
| Contributions received from participants | 2017-06-30 | $454,450 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-06-30 | $377,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-06-30 | $398,000 |
| Administrative expenses (other) incurred | 2017-06-30 | $12,326 |
| Liabilities. Value of operating payables at end of year | 2017-06-30 | $84,522 |
| Liabilities. Value of operating payables at beginning of year | 2017-06-30 | $70,916 |
| Total non interest bearing cash at end of year | 2017-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2017-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Value of net income/loss | 2017-06-30 | $1,055,127 |
| Value of net assets at end of year (total assets less liabilities) | 2017-06-30 | $7,781,615 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-06-30 | $6,726,488 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-06-30 | No |
| Investment advisory and management fees | 2017-06-30 | $5,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-06-30 | $5,566,880 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-06-30 | $4,543,095 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-06-30 | $1,413,049 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-06-30 | $1,296,101 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-06-30 | $1,296,101 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-06-30 | $905 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-06-30 | $5,177,767 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-06-30 | $59,808 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-06-30 | No |
| Contributions received in cash from employer | 2017-06-30 | $5,953,363 |
| Employer contributions (assets) at end of year | 2017-06-30 | $504,000 |
| Employer contributions (assets) at beginning of year | 2017-06-30 | $555,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-06-30 | $0 |
| Contract administrator fees | 2017-06-30 | $216,722 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-06-30 | No |
| Did the plan have assets held for investment | 2017-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-06-30 | Unqualified |
| Accountancy firm name | 2017-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2017-06-30 | 522385296 |
| 2016 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $70,916 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $73,762 |
| Total income from all sources (including contributions) | 2016-06-30 | $6,304,943 |
| Total of all expenses incurred | 2016-06-30 | $5,230,097 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-06-30 | $4,918,861 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-06-30 | $6,138,700 |
| Value of total assets at end of year | 2016-06-30 | $6,797,404 |
| Value of total assets at beginning of year | 2016-06-30 | $5,725,404 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-06-30 | $311,236 |
| Total interest from all sources | 2016-06-30 | $492 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-06-30 | $99,183 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-06-30 | $99,183 |
| Administrative expenses professional fees incurred | 2016-06-30 | $107,104 |
| Was this plan covered by a fidelity bond | 2016-06-30 | Yes |
| Value of fidelity bond cover | 2016-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-06-30 | No |
| Contributions received from participants | 2016-06-30 | $479,321 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-06-30 | $398,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-06-30 | $359,000 |
| Administrative expenses (other) incurred | 2016-06-30 | $16,634 |
| Liabilities. Value of operating payables at end of year | 2016-06-30 | $70,916 |
| Liabilities. Value of operating payables at beginning of year | 2016-06-30 | $73,762 |
| Total non interest bearing cash at end of year | 2016-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2016-06-30 | $8,163 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Value of net income/loss | 2016-06-30 | $1,074,846 |
| Value of net assets at end of year (total assets less liabilities) | 2016-06-30 | $6,726,488 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-06-30 | $5,651,642 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-06-30 | No |
| Investment advisory and management fees | 2016-06-30 | $5,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-06-30 | $4,543,095 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-06-30 | $4,377,346 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-06-30 | $1,296,101 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-06-30 | $657,895 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-06-30 | $657,895 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-06-30 | $492 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-06-30 | $4,916,892 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-06-30 | $66,568 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-06-30 | No |
| Contributions received in cash from employer | 2016-06-30 | $5,659,379 |
| Employer contributions (assets) at end of year | 2016-06-30 | $555,000 |
| Employer contributions (assets) at beginning of year | 2016-06-30 | $323,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-06-30 | $1,969 |
| Contract administrator fees | 2016-06-30 | $182,498 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-06-30 | No |
| Did the plan have assets held for investment | 2016-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-06-30 | Unqualified |
| Accountancy firm name | 2016-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2016-06-30 | 522385296 |
| 2015 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $73,762 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $70,868 |
| Total income from all sources (including contributions) | 2015-06-30 | $4,722,385 |
| Total of all expenses incurred | 2015-06-30 | $4,823,610 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-06-30 | $4,514,427 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-06-30 | $4,661,681 |
| Value of total assets at end of year | 2015-06-30 | $5,725,404 |
| Value of total assets at beginning of year | 2015-06-30 | $5,823,735 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-06-30 | $309,183 |
| Total interest from all sources | 2015-06-30 | $441 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-06-30 | $84,884 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-06-30 | $84,884 |
| Administrative expenses professional fees incurred | 2015-06-30 | $98,505 |
| Was this plan covered by a fidelity bond | 2015-06-30 | Yes |
| Value of fidelity bond cover | 2015-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-06-30 | No |
| Contributions received from participants | 2015-06-30 | $594,675 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-06-30 | $359,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-06-30 | $336,000 |
| Administrative expenses (other) incurred | 2015-06-30 | $17,449 |
| Liabilities. Value of operating payables at end of year | 2015-06-30 | $73,762 |
| Liabilities. Value of operating payables at beginning of year | 2015-06-30 | $70,868 |
| Total non interest bearing cash at end of year | 2015-06-30 | $8,163 |
| Total non interest bearing cash at beginning of year | 2015-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Value of net income/loss | 2015-06-30 | $-101,225 |
| Value of net assets at end of year (total assets less liabilities) | 2015-06-30 | $5,651,642 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-06-30 | $5,752,867 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-06-30 | No |
| Investment advisory and management fees | 2015-06-30 | $5,120 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-06-30 | $4,377,346 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-06-30 | $4,317,080 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-06-30 | $657,895 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-06-30 | $770,447 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-06-30 | $770,447 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-06-30 | $441 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-06-30 | $4,508,574 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-06-30 | $-24,621 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-06-30 | No |
| Contributions received in cash from employer | 2015-06-30 | $4,067,006 |
| Employer contributions (assets) at end of year | 2015-06-30 | $323,000 |
| Employer contributions (assets) at beginning of year | 2015-06-30 | $395,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-06-30 | $5,853 |
| Contract administrator fees | 2015-06-30 | $188,109 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-06-30 | No |
| Did the plan have assets held for investment | 2015-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-06-30 | Unqualified |
| Accountancy firm name | 2015-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2015-06-30 | 522385296 |
| 2014 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $70,868 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $92,609 |
| Total income from all sources (including contributions) | 2014-06-30 | $5,000,484 |
| Total of all expenses incurred | 2014-06-30 | $5,069,364 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-06-30 | $4,748,317 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-06-30 | $4,750,066 |
| Value of total assets at end of year | 2014-06-30 | $5,823,735 |
| Value of total assets at beginning of year | 2014-06-30 | $5,914,356 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-06-30 | $321,047 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-06-30 | $76,939 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-06-30 | $76,939 |
| Administrative expenses professional fees incurred | 2014-06-30 | $118,884 |
| Was this plan covered by a fidelity bond | 2014-06-30 | Yes |
| Value of fidelity bond cover | 2014-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-06-30 | No |
| Contributions received from participants | 2014-06-30 | $546,843 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-06-30 | $336,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-06-30 | $375,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-06-30 | $21,651 |
| Administrative expenses (other) incurred | 2014-06-30 | $26,428 |
| Liabilities. Value of operating payables at end of year | 2014-06-30 | $70,868 |
| Liabilities. Value of operating payables at beginning of year | 2014-06-30 | $70,958 |
| Total non interest bearing cash at end of year | 2014-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2014-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Value of net income/loss | 2014-06-30 | $-68,880 |
| Value of net assets at end of year (total assets less liabilities) | 2014-06-30 | $5,752,867 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-06-30 | $5,821,747 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-06-30 | No |
| Investment advisory and management fees | 2014-06-30 | $3,820 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-06-30 | $4,317,080 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-06-30 | $3,732,195 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-06-30 | $770,447 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-06-30 | $1,395,953 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-06-30 | $1,395,953 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-06-30 | $4,741,649 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-06-30 | $173,479 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-06-30 | No |
| Contributions received in cash from employer | 2014-06-30 | $4,203,223 |
| Employer contributions (assets) at end of year | 2014-06-30 | $395,000 |
| Employer contributions (assets) at beginning of year | 2014-06-30 | $406,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-06-30 | $6,668 |
| Contract administrator fees | 2014-06-30 | $171,915 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-06-30 | No |
| Did the plan have assets held for investment | 2014-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-06-30 | Unqualified |
| Accountancy firm name | 2014-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2014-06-30 | 522385296 |
| 2013 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $92,609 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $71,376 |
| Total income from all sources (including contributions) | 2013-06-30 | $5,806,868 |
| Total of all expenses incurred | 2013-06-30 | $5,122,423 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-06-30 | $4,844,513 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-06-30 | $5,686,112 |
| Value of total assets at end of year | 2013-06-30 | $5,914,356 |
| Value of total assets at beginning of year | 2013-06-30 | $5,208,678 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-06-30 | $277,910 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-06-30 | $113,678 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-06-30 | $113,678 |
| Administrative expenses professional fees incurred | 2013-06-30 | $103,403 |
| Was this plan covered by a fidelity bond | 2013-06-30 | Yes |
| Value of fidelity bond cover | 2013-06-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-06-30 | No |
| Contributions received from participants | 2013-06-30 | $468,474 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-06-30 | $375,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-06-30 | $369,651 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-06-30 | $21,651 |
| Administrative expenses (other) incurred | 2013-06-30 | $16,721 |
| Liabilities. Value of operating payables at end of year | 2013-06-30 | $70,958 |
| Liabilities. Value of operating payables at beginning of year | 2013-06-30 | $71,376 |
| Total non interest bearing cash at end of year | 2013-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2013-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Value of net income/loss | 2013-06-30 | $684,445 |
| Value of net assets at end of year (total assets less liabilities) | 2013-06-30 | $5,821,747 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-06-30 | $5,137,302 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-06-30 | No |
| Investment advisory and management fees | 2013-06-30 | $5,030 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-06-30 | $3,732,195 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-06-30 | $3,611,966 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-06-30 | $1,395,953 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-06-30 | $730,853 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-06-30 | $730,853 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-06-30 | $4,831,597 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-06-30 | $7,078 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-06-30 | No |
| Contributions received in cash from employer | 2013-06-30 | $5,217,638 |
| Employer contributions (assets) at end of year | 2013-06-30 | $406,000 |
| Employer contributions (assets) at beginning of year | 2013-06-30 | $491,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-06-30 | $12,916 |
| Contract administrator fees | 2013-06-30 | $152,756 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-06-30 | No |
| Did the plan have assets held for investment | 2013-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-06-30 | Unqualified |
| Accountancy firm name | 2013-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2013-06-30 | 522385296 |
| 2012 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $71,376 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $70,537 |
| Total income from all sources (including contributions) | 2012-06-30 | $4,615,799 |
| Total of all expenses incurred | 2012-06-30 | $4,466,760 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $4,199,671 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $4,424,297 |
| Value of total assets at end of year | 2012-06-30 | $5,208,678 |
| Value of total assets at beginning of year | 2012-06-30 | $5,058,800 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $267,089 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-06-30 | $110,817 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-06-30 | $110,817 |
| Administrative expenses professional fees incurred | 2012-06-30 | $100,931 |
| Was this plan covered by a fidelity bond | 2012-06-30 | Yes |
| Value of fidelity bond cover | 2012-06-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Contributions received from participants | 2012-06-30 | $572,479 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-06-30 | $369,651 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-06-30 | $276,953 |
| Administrative expenses (other) incurred | 2012-06-30 | $13,723 |
| Liabilities. Value of operating payables at end of year | 2012-06-30 | $71,376 |
| Liabilities. Value of operating payables at beginning of year | 2012-06-30 | $70,537 |
| Total non interest bearing cash at end of year | 2012-06-30 | $5,208 |
| Total non interest bearing cash at beginning of year | 2012-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $149,039 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $5,137,302 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $4,988,263 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Investment advisory and management fees | 2012-06-30 | $4,066 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-06-30 | $3,611,966 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-06-30 | $4,021,075 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-06-30 | $730,853 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-06-30 | $611,564 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-06-30 | $611,564 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-06-30 | $4,196,754 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-06-30 | $80,685 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $3,851,818 |
| Employer contributions (assets) at end of year | 2012-06-30 | $491,000 |
| Employer contributions (assets) at beginning of year | 2012-06-30 | $144,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-06-30 | $2,917 |
| Contract administrator fees | 2012-06-30 | $148,369 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-06-30 | No |
| Did the plan have assets held for investment | 2012-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Unqualified |
| Accountancy firm name | 2012-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2012-06-30 | 522385296 |
| 2011 : PLUMBERS & STEAMFITTERS MANAGED HEALTH CARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $70,537 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $18,087 |
| Total income from all sources (including contributions) | 2011-06-30 | $4,249,523 |
| Total of all expenses incurred | 2011-06-30 | $5,038,201 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $4,776,555 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $4,116,778 |
| Value of total assets at end of year | 2011-06-30 | $5,058,800 |
| Value of total assets at beginning of year | 2011-06-30 | $5,795,028 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $261,646 |
| Total interest from all sources | 2011-06-30 | $3,811 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-06-30 | $53,514 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-06-30 | $53,514 |
| Administrative expenses professional fees incurred | 2011-06-30 | $121,273 |
| Was this plan covered by a fidelity bond | 2011-06-30 | Yes |
| Value of fidelity bond cover | 2011-06-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $427,870 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-06-30 | $276,953 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-06-30 | $461,014 |
| Administrative expenses (other) incurred | 2011-06-30 | $12,797 |
| Liabilities. Value of operating payables at end of year | 2011-06-30 | $70,537 |
| Liabilities. Value of operating payables at beginning of year | 2011-06-30 | $18,087 |
| Total non interest bearing cash at end of year | 2011-06-30 | $5,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $-788,678 |
| Value of net assets at end of year (total assets less liabilities) | 2011-06-30 | $4,988,263 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $5,776,941 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-06-30 | $4,021,075 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-06-30 | $1,389,964 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-06-30 | $611,564 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-06-30 | $3,439,050 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-06-30 | $3,439,050 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-06-30 | $3,811 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $4,765,831 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-06-30 | $75,420 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $3,688,908 |
| Employer contributions (assets) at end of year | 2011-06-30 | $144,000 |
| Employer contributions (assets) at beginning of year | 2011-06-30 | $505,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-06-30 | $10,724 |
| Contract administrator fees | 2011-06-30 | $127,576 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-06-30 | No |
| Did the plan have assets held for investment | 2011-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2011-06-30 | 522385296 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $876,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 1 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,733 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 703 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,737,525 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 9 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $56,560 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $35,807 | | 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 number | 5504122 |
| Policy instance | 5 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1465 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $32,859 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND 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 Carrier | USD $620,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,617 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 6 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | S5921 |
| Policy instance | 7 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $54,105 | | 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 number | SRSUP |
| Policy instance | 8 |
| Insurance contract or identification number | SRSUP | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $52,534 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 774 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,001,860 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $746,832 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $34,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,304 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,331 | | 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 number | SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | SRSUP | | Number of Individuals Covered | 21 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | S5921 |
| Policy instance | 9 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $56,449 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1497 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $31,682 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $592,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,427 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $9,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | S5921 |
| Policy instance | 9 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $49,709 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,462 | | 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 number | SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | SRSUP | | Number of Individuals Covered | 22 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,193 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $770,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $9,733 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 776 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,026,927 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1543 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $35,523 | | Total amount of fees paid to insurance company | USD $103 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $673,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,158 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 103 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 335 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,304 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $31,774 | | 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 number | SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | SRSUP | | Number of Individuals Covered | 19 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | S5921 |
| Policy instance | 9 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $50,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $9,377 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,511 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $51,711 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $701,848 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 767 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,695,714 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1563 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $33,905 | | Total amount of fees paid to insurance company | USD $74 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $641,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,569 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 74 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $58,384 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $767,080 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 731 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,477,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $9,377 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,631 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1396 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $29,964 | | Total amount of fees paid to insurance company | USD $122 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $565,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,488 | | 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 number | SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | SRSUP | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | S5921 |
| Policy instance | 9 |
| Insurance contract or identification number | S5921 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $48,468 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1144 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $22,764 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $404,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,685 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 659 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,582,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $650,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $30,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,930 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5921/SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | S5921/SRSUP | | Number of Individuals Covered | 25 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,619 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 981 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $18,573 | | Total amount of fees paid to insurance company | USD $112 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $357,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,534 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 112 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | ROGERS BENEFIT GROUP, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 592 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,197,474 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $674,526 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $74,081 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,460 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,930 | | 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 number | S5921/SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | S5921/SRSUP | | Number of Individuals Covered | 20 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $111,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 665 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,369,236 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $19,227 | | Total amount of fees paid to insurance company | USD $51 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $376,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,238 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 51 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | ROGERS BENEFIT GROUP, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $608,034 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $86,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 5 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 6 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,930 | | 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 number | S5921/SRSUP |
| Policy instance | 7 |
| Insurance contract or identification number | S5921/SRSUP | | Number of Individuals Covered | 20 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 8 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,767 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 557 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $3,476 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $30,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,258 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 765 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,522,079 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 10 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,772 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $496,619 | | 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 number | 7909 |
| Policy instance | 4 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $40,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 7377 & 7378 |
| Policy instance | 5 |
| Insurance contract or identification number | 7377 & 7378 | | Number of Individuals Covered | 784 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $453,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 6 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 7 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,821 | | 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 number | S5921/SRSUP |
| Policy instance | 8 |
| Insurance contract or identification number | S5921/SRSUP | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $118,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101436 |
| Policy instance | 9 |
| Insurance contract or identification number | 101436 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $2,134 | | 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 number | 7909 |
| Policy instance | 5 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $30,555 | | 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 number | S5921/SRSUP |
| Policy instance | 10 |
| Insurance contract or identification number | S5921/SRSUP | | Number of Individuals Covered | 54 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,652 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 522 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $3,367 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $29,596 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 770 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $2,890,060 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $476,598 | | 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 number | 60305 |
| Policy instance | 4 |
| Insurance contract or identification number | 60305 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $28,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 7377 & 7378 |
| Policy instance | 6 |
| Insurance contract or identification number | 7377 & 7378 | | Number of Individuals Covered | 728 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $338,143 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 7 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 8 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $8,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101417 |
| Policy instance | 9 |
| Insurance contract or identification number | 101417 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101417 |
| Policy instance | 5 |
| Insurance contract or identification number | 101417 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $561,114 | | 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 number | 60306 |
| Policy instance | 3 |
| Insurance contract or identification number | 60306 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $339,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 3283 |
| Policy instance | 12 |
| Insurance contract or identification number | 3283 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $7,050 | | 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 number | 5504122 |
| Policy instance | 1 |
| Insurance contract or identification number | 5504122 | | Number of Individuals Covered | 485 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $3,881 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $34,748 | | 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 number | 60305 |
| Policy instance | 4 |
| Insurance contract or identification number | 60305 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $48,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 101432 |
| Policy instance | 6 |
| Insurance contract or identification number | 101432 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,796 | | 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 number | 7909 |
| Policy instance | 7 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $24,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 7377 & 7378 |
| Policy instance | 8 |
| Insurance contract or identification number | 7377 & 7378 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $506,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30008580 |
| Policy instance | 9 |
| Insurance contract or identification number | 30008580 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFICARE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70785 ) |
| Policy contract number | 14825 |
| Policy instance | 10 |
| Insurance contract or identification number | 14825 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,808 | | 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 number | S5921 & SRSUP |
| Policy instance | 11 |
| Insurance contract or identification number | S5921 & SRSUP | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,851 | | 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 number | 60304 |
| Policy instance | 2 |
| Insurance contract or identification number | 60304 | | Number of Individuals Covered | 690 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $2,910,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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