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SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number 501

SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

SAN YSIDRO HEALTH CENTER, INC has sponsored the creation of one or more 401k plans.

Company Name:SAN YSIDRO HEALTH CENTER, INC
Employer identification number (EIN):952801772
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-05-01BRIAN WALLACE2023-10-12
5012021-05-01BRIAN WALLACE2022-11-03
5012020-05-01BRIAN WALLACE2022-08-29
5012019-05-01
5012019-05-01
5012018-05-01
5012018-05-01BRIAN WALLACE2022-08-29
5012017-05-01GILBERT FIMBRES, CFO
5012017-05-01
5012017-05-01BRIAN WALLACE2022-08-29
5012016-05-01GILBERT FIMBRES, CFO
5012016-05-01BRIAN WALLACE2022-08-29
5012015-05-01GILBERT FIMBRES, CFO
5012015-05-01BRIAN WALLACE2022-08-29
5012014-05-01GILBERT FIMBRES, CFO
5012014-05-01BRIAN WALLACE2022-08-29
5012013-05-01GILBERT FIMBRES, CFO
5012013-05-01BRIAN WALLACE2022-08-29
5012012-05-01TONY WEBER, CFO
5012012-05-01BRIAN WALLACE2022-08-29
5012011-05-01TONY WEBER CFO
5012011-05-01BRIAN WALLACE2022-08-29
5012010-05-01TONY WEBER CFO
5012010-05-01BRIAN WALLACE2022-08-29
5012009-05-01KEVIN MATTSON CFO
5012009-05-01BRIAN WALLACE2022-08-29

Plan Statistics for SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2022: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-011,979
Total number of active participants reported on line 7a of the Form 55002022-05-012,152
Number of retired or separated participants receiving benefits2022-05-011
Number of other retired or separated participants entitled to future benefits2022-05-011
Total of all active and inactive participants2022-05-012,154
Number of employers contributing to the scheme2022-05-010
2021: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-012,000
Total number of active participants reported on line 7a of the Form 55002021-05-011,783
Number of retired or separated participants receiving benefits2021-05-013
Number of other retired or separated participants entitled to future benefits2021-05-012
Total of all active and inactive participants2021-05-011,788
Number of employers contributing to the scheme2021-05-010
2020: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-011,037
Total number of active participants reported on line 7a of the Form 55002020-05-011,333
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-011,333
Number of employers contributing to the scheme2020-05-010
2019: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-011,361
Total number of active participants reported on line 7a of the Form 55002019-05-011,400
Total of all active and inactive participants2019-05-011,400
Total participants2019-05-011,400
2018: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-011,123
Total number of active participants reported on line 7a of the Form 55002018-05-011,025
Total of all active and inactive participants2018-05-011,025
Total participants2018-05-011,025
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Number of employers contributing to the scheme2018-05-010
2017: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-010
Total number of active participants reported on line 7a of the Form 55002017-05-011,123
Total of all active and inactive participants2017-05-011,123
Total participants2017-05-011,123
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Number of employers contributing to the scheme2017-05-010
2016: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-010
Total number of active participants reported on line 7a of the Form 55002016-05-011,127
Total of all active and inactive participants2016-05-011,127
Total participants2016-05-011,127
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Number of employers contributing to the scheme2016-05-010
2015: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-010
Total number of active participants reported on line 7a of the Form 55002015-05-01983
Total of all active and inactive participants2015-05-01983
Total participants2015-05-010
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Number of employers contributing to the scheme2015-05-010
2014: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-010
Total number of active participants reported on line 7a of the Form 55002014-05-01927
Total of all active and inactive participants2014-05-01927
Total participants2014-05-010
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Number of employers contributing to the scheme2014-05-010
2013: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01734
Total number of active participants reported on line 7a of the Form 55002013-05-01761
Total of all active and inactive participants2013-05-01761
Total participants2013-05-010
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Number of employers contributing to the scheme2013-05-010
2012: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01656
Total number of active participants reported on line 7a of the Form 55002012-05-01734
Total of all active and inactive participants2012-05-01734
Total participants2012-05-010
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Number of employers contributing to the scheme2012-05-010
2011: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01583
Total number of active participants reported on line 7a of the Form 55002011-05-01656
Total of all active and inactive participants2011-05-01656
Total participants2011-05-01656
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Number of employers contributing to the scheme2011-05-010
2010: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-01584
Total number of active participants reported on line 7a of the Form 55002010-05-01583
Total of all active and inactive participants2010-05-01583
Total participants2010-05-01583
Number of retired or separated participants receiving benefits2010-05-010
Number of other retired or separated participants entitled to future benefits2010-05-010
Number of employers contributing to the scheme2010-05-010
2009: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01503
Total number of active participants reported on line 7a of the Form 55002009-05-01584
Total of all active and inactive participants2009-05-01584
Total participants2009-05-01584
Number of retired or separated participants receiving benefits2009-05-010
Number of other retired or separated participants entitled to future benefits2009-05-010
Number of employers contributing to the scheme2009-05-010

Financial Data on SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2020 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-04-30$73,708
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-04-30$73,944
Total income from all sources (including contributions)2020-04-30$12,007,469
Total of all expenses incurred2020-04-30$12,025,709
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-04-30$11,926,118
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-04-30$12,007,469
Value of total assets at end of year2020-04-30$105,001
Value of total assets at beginning of year2020-04-30$123,477
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-04-30$99,591
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-04-30No
Was this plan covered by a fidelity bond2020-04-30No
If this is an individual account plan, was there a blackout period2020-04-30No
Were there any nonexempt tranactions with any party-in-interest2020-04-30No
Contributions received from participants2020-04-30$2,438,962
Income. Received or receivable in cash from other sources (including rollovers)2020-04-30$21,589
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-04-30$600,822
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-04-30$73,708
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-04-30$73,944
Total non interest bearing cash at end of year2020-04-30$189
Total non interest bearing cash at beginning of year2020-04-30$18,429
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-04-30No
Value of net income/loss2020-04-30$-18,240
Value of net assets at end of year (total assets less liabilities)2020-04-30$31,293
Value of net assets at beginning of year (total assets less liabilities)2020-04-30$49,533
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-04-30No
Were any leases to which the plan was party in default or uncollectible2020-04-30No
Value of interest in pooled separate accounts at end of year2020-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2020-04-30$11,152,417
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-04-30No
Was there a failure to transmit to the plan any participant contributions2020-04-30No
Has the plan failed to provide any benefit when due under the plan2020-04-30No
Contributions received in cash from employer2020-04-30$9,546,918
Employer contributions (assets) at end of year2020-04-30$104,812
Employer contributions (assets) at beginning of year2020-04-30$105,048
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-04-30$172,879
Contract administrator fees2020-04-30$99,591
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-04-30No
Did the plan have assets held for investment2020-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-04-30No
Opinion of an independent qualified public accountant for this plan2020-04-30Unqualified
Accountancy firm name2020-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2020-04-30043595246
2019 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-04-30$73,944
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-04-30$111,065
Total income from all sources (including contributions)2019-04-30$10,319,433
Total of all expenses incurred2019-04-30$10,290,364
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-04-30$10,199,358
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-04-30$10,319,433
Value of total assets at end of year2019-04-30$123,477
Value of total assets at beginning of year2019-04-30$131,529
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-04-30$91,006
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-04-30No
Was this plan covered by a fidelity bond2019-04-30No
If this is an individual account plan, was there a blackout period2019-04-30No
Were there any nonexempt tranactions with any party-in-interest2019-04-30No
Contributions received from participants2019-04-30$2,138,072
Income. Received or receivable in cash from other sources (including rollovers)2019-04-30$47,758
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-04-30$608,103
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-04-30$73,944
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-04-30$111,065
Total non interest bearing cash at end of year2019-04-30$18,429
Total non interest bearing cash at beginning of year2019-04-30$18,615
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-04-30No
Value of net income/loss2019-04-30$29,069
Value of net assets at end of year (total assets less liabilities)2019-04-30$49,533
Value of net assets at beginning of year (total assets less liabilities)2019-04-30$20,464
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-04-30No
Were any leases to which the plan was party in default or uncollectible2019-04-30No
Value of interest in pooled separate accounts at end of year2019-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-04-30$9,420,117
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-04-30No
Was there a failure to transmit to the plan any participant contributions2019-04-30No
Has the plan failed to provide any benefit when due under the plan2019-04-30No
Contributions received in cash from employer2019-04-30$8,133,603
Employer contributions (assets) at end of year2019-04-30$105,048
Employer contributions (assets) at beginning of year2019-04-30$112,914
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-04-30$171,138
Contract administrator fees2019-04-30$91,006
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-04-30No
Did the plan have assets held for investment2019-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-04-30No
Opinion of an independent qualified public accountant for this plan2019-04-30Unqualified
Accountancy firm name2019-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2019-04-30043595246
2018 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-04-30$111,065
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-04-30$81,788
Total income from all sources (including contributions)2018-04-30$9,373,392
Total of all expenses incurred2018-04-30$9,371,432
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-04-30$9,291,045
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-04-30$9,373,392
Value of total assets at end of year2018-04-30$131,529
Value of total assets at beginning of year2018-04-30$100,292
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-04-30$80,387
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-04-30No
Was this plan covered by a fidelity bond2018-04-30No
If this is an individual account plan, was there a blackout period2018-04-30No
Were there any nonexempt tranactions with any party-in-interest2018-04-30No
Contributions received from participants2018-04-30$1,963,974
Income. Received or receivable in cash from other sources (including rollovers)2018-04-30$22,012
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-04-30$538,207
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-04-30$111,065
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-04-30$81,788
Total non interest bearing cash at end of year2018-04-30$18,615
Total non interest bearing cash at beginning of year2018-04-30$18,569
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-04-30No
Value of net income/loss2018-04-30$1,960
Value of net assets at end of year (total assets less liabilities)2018-04-30$20,464
Value of net assets at beginning of year (total assets less liabilities)2018-04-30$18,504
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-04-30No
Were any leases to which the plan was party in default or uncollectible2018-04-30No
Value of interest in common/collective trusts at end of year2018-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2018-04-30$8,576,680
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-04-30No
Was there a failure to transmit to the plan any participant contributions2018-04-30No
Has the plan failed to provide any benefit when due under the plan2018-04-30No
Contributions received in cash from employer2018-04-30$7,387,406
Employer contributions (assets) at end of year2018-04-30$112,914
Employer contributions (assets) at beginning of year2018-04-30$81,723
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-04-30$176,158
Contract administrator fees2018-04-30$80,387
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-04-30No
Did the plan have assets held for investment2018-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-04-30No
Opinion of an independent qualified public accountant for this plan2018-04-30Unqualified
Accountancy firm name2018-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2018-04-30043595246
2017 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-04-30$81,788
Total plan liabilities at beginning of year2017-04-30$23,435
Total income from all sources2017-04-30$8,084,268
Expenses. Total of all expenses incurred2017-04-30$8,084,269
Benefits paid (including direct rollovers)2017-04-30$7,997,317
Total plan assets at end of year2017-04-30$100,292
Total plan assets at beginning of year2017-04-30$41,940
Total contributions received or receivable from participants2017-04-30$1,823,446
Expenses. Other expenses not covered elsewhere2017-04-30$86,952
Contributions received from other sources (not participants or employers)2017-04-30$15,427
Net income (gross income less expenses)2017-04-30$-1
Net plan assets at end of year (total assets less liabilities)2017-04-30$18,504
Net plan assets at beginning of year (total assets less liabilities)2017-04-30$18,505
Total contributions received or receivable from employer(s)2017-04-30$6,245,395
2016 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-04-30$23,435
Total plan liabilities at beginning of year2016-04-30$55,493
Total income from all sources2016-04-30$7,072,821
Expenses. Total of all expenses incurred2016-04-30$7,086,114
Benefits paid (including direct rollovers)2016-04-30$7,000,385
Total plan assets at end of year2016-04-30$41,940
Total plan assets at beginning of year2016-04-30$87,291
Total contributions received or receivable from participants2016-04-30$1,550,811
Expenses. Other expenses not covered elsewhere2016-04-30$85,729
Contributions received from other sources (not participants or employers)2016-04-30$7,174
Net income (gross income less expenses)2016-04-30$-13,293
Net plan assets at end of year (total assets less liabilities)2016-04-30$18,505
Net plan assets at beginning of year (total assets less liabilities)2016-04-30$31,798
Total contributions received or receivable from employer(s)2016-04-30$5,514,836
2015 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-04-30$55,493
Total plan liabilities at beginning of year2015-04-30$23,619
Total income from all sources2015-04-30$6,341,492
Expenses. Total of all expenses incurred2015-04-30$6,355,050
Benefits paid (including direct rollovers)2015-04-30$6,261,887
Total plan assets at end of year2015-04-30$87,291
Total plan assets at beginning of year2015-04-30$68,975
Total contributions received or receivable from participants2015-04-30$1,386,860
Expenses. Other expenses not covered elsewhere2015-04-30$93,163
Contributions received from other sources (not participants or employers)2015-04-30$15,141
Net income (gross income less expenses)2015-04-30$-13,558
Net plan assets at end of year (total assets less liabilities)2015-04-30$31,798
Net plan assets at beginning of year (total assets less liabilities)2015-04-30$45,356
Total contributions received or receivable from employer(s)2015-04-30$4,939,491
2014 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-04-30$23,619
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-04-30$17,434
Total income from all sources (including contributions)2014-04-30$5,597,683
Total of all expenses incurred2014-04-30$5,590,196
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-04-30$5,492,754
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-04-30$5,597,683
Value of total assets at end of year2014-04-30$68,975
Value of total assets at beginning of year2014-04-30$55,303
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-04-30$97,442
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-04-30No
Was this plan covered by a fidelity bond2014-04-30No
If this is an individual account plan, was there a blackout period2014-04-30No
Were there any nonexempt tranactions with any party-in-interest2014-04-30No
Contributions received from participants2014-04-30$1,280,106
Income. Received or receivable in cash from other sources (including rollovers)2014-04-30$30,763
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-04-30$646,631
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-04-30$23,619
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-04-30$17,434
Total non interest bearing cash at end of year2014-04-30$18,473
Total non interest bearing cash at beginning of year2014-04-30$9,773
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Value of net income/loss2014-04-30$7,487
Value of net assets at end of year (total assets less liabilities)2014-04-30$45,356
Value of net assets at beginning of year (total assets less liabilities)2014-04-30$37,869
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-04-30No
Were any leases to which the plan was party in default or uncollectible2014-04-30No
Value of interest in common/collective trusts at end of year2014-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2014-04-30$4,733,689
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-04-30No
Was there a failure to transmit to the plan any participant contributions2014-04-30No
Has the plan failed to provide any benefit when due under the plan2014-04-30No
Contributions received in cash from employer2014-04-30$4,286,814
Employer contributions (assets) at end of year2014-04-30$50,502
Employer contributions (assets) at beginning of year2014-04-30$45,530
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-04-30$112,434
Contract administrator fees2014-04-30$97,442
Did the plan have assets held for investment2014-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-04-30No
Opinion of an independent qualified public accountant for this plan2014-04-30Unqualified
Accountancy firm name2014-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2014-04-30043595246
2013 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-04-30$17,434
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-04-30$16,649
Total income from all sources (including contributions)2013-04-30$5,062,166
Total of all expenses incurred2013-04-30$5,035,507
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-04-30$4,944,854
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-04-30$5,062,166
Value of total assets at end of year2013-04-30$55,303
Value of total assets at beginning of year2013-04-30$27,859
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-04-30$90,653
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-04-30No
Was this plan covered by a fidelity bond2013-04-30No
Were there any nonexempt tranactions with any party-in-interest2013-04-30No
Contributions received from participants2013-04-30$1,141,641
Income. Received or receivable in cash from other sources (including rollovers)2013-04-30$31,525
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-04-30$535,025
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-04-30$17,434
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-04-30$16,649
Total non interest bearing cash at end of year2013-04-30$9,773
Total non interest bearing cash at beginning of year2013-04-30$1,310
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Value of net income/loss2013-04-30$26,659
Value of net assets at end of year (total assets less liabilities)2013-04-30$37,869
Value of net assets at beginning of year (total assets less liabilities)2013-04-30$11,210
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-04-30No
Were any leases to which the plan was party in default or uncollectible2013-04-30No
Value of interest in common/collective trusts at end of year2013-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2013-04-30$4,315,579
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-04-30No
Was there a failure to transmit to the plan any participant contributions2013-04-30No
Has the plan failed to provide any benefit when due under the plan2013-04-30No
Contributions received in cash from employer2013-04-30$3,889,000
Employer contributions (assets) at end of year2013-04-30$45,530
Employer contributions (assets) at beginning of year2013-04-30$26,549
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-04-30$94,250
Contract administrator fees2013-04-30$90,653
Did the plan have assets held for investment2013-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-04-30No
Opinion of an independent qualified public accountant for this plan2013-04-30Unqualified
Accountancy firm name2013-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2013-04-30043595246
2012 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-04-30$16,649
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-04-30$13,545
Total income from all sources (including contributions)2012-04-30$4,335,299
Total of all expenses incurred2012-04-30$4,351,979
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-04-30$4,270,774
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-04-30$4,335,299
Value of total assets at end of year2012-04-30$27,859
Value of total assets at beginning of year2012-04-30$41,435
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-04-30$81,205
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-04-30No
Was this plan covered by a fidelity bond2012-04-30No
Were there any nonexempt tranactions with any party-in-interest2012-04-30No
Contributions received from participants2012-04-30$1,005,703
Income. Received or receivable in cash from other sources (including rollovers)2012-04-30$10,239
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-04-30$502,748
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-04-30$16,649
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-04-30$13,545
Total non interest bearing cash at end of year2012-04-30$1,310
Total non interest bearing cash at beginning of year2012-04-30$3,236
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Value of net income/loss2012-04-30$-16,680
Value of net assets at end of year (total assets less liabilities)2012-04-30$11,210
Value of net assets at beginning of year (total assets less liabilities)2012-04-30$27,890
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-04-30No
Were any leases to which the plan was party in default or uncollectible2012-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-04-30$3,696,333
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-04-30No
Was there a failure to transmit to the plan any participant contributions2012-04-30No
Has the plan failed to provide any benefit when due under the plan2012-04-30No
Contributions received in cash from employer2012-04-30$3,319,357
Employer contributions (assets) at end of year2012-04-30$26,549
Employer contributions (assets) at beginning of year2012-04-30$38,199
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-04-30$71,693
Contract administrator fees2012-04-30$81,205
Did the plan have assets held for investment2012-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-04-30No
Opinion of an independent qualified public accountant for this plan2012-04-30Unqualified
Accountancy firm name2012-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2012-04-30043595246
2011 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-04-30$13,545
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-04-30$10,721
Total income from all sources (including contributions)2011-04-30$3,705,639
Total of all expenses incurred2011-04-30$3,684,484
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-04-30$3,588,038
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-04-30$3,705,639
Value of total assets at end of year2011-04-30$41,435
Value of total assets at beginning of year2011-04-30$17,456
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-04-30$96,446
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-04-30No
Was this plan covered by a fidelity bond2011-04-30No
Were there any nonexempt tranactions with any party-in-interest2011-04-30No
Contributions received from participants2011-04-30$957,764
Income. Received or receivable in cash from other sources (including rollovers)2011-04-30$25,488
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-04-30$462,231
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-04-30$13,545
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-04-30$10,721
Administrative expenses (other) incurred2011-04-30$9,954
Total non interest bearing cash at end of year2011-04-30$3,236
Total non interest bearing cash at beginning of year2011-04-30$6,735
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Value of net income/loss2011-04-30$21,155
Value of net assets at end of year (total assets less liabilities)2011-04-30$27,890
Value of net assets at beginning of year (total assets less liabilities)2011-04-30$6,735
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-04-30No
Were any leases to which the plan was party in default or uncollectible2011-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2011-04-30$3,035,237
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-04-30No
Was there a failure to transmit to the plan any participant contributions2011-04-30No
Has the plan failed to provide any benefit when due under the plan2011-04-30No
Contributions received in cash from employer2011-04-30$2,722,387
Employer contributions (assets) at end of year2011-04-30$38,199
Employer contributions (assets) at beginning of year2011-04-30$10,721
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-04-30$90,570
Contract administrator fees2011-04-30$86,492
Did the plan have assets held for investment2011-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-04-30No
Opinion of an independent qualified public accountant for this plan2011-04-30Unqualified
Accountancy firm name2011-04-30STACK AND ASSOCIATES, CPAS
Accountancy firm EIN2011-04-30043595246

Form 5500 Responses for SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN

2022: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – General assets of the sponsorYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – General assets of the sponsorYes
2021: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan funding arrangement – General assets of the sponsorYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – General assets of the sponsorYes
2020: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan funding arrangement – General assets of the sponsorYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – General assets of the sponsorYes
2019: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedYes
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – TrustYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement - TrustYes
2018: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedYes
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan funding arrangement – TrustYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement - TrustYes
2017: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedYes
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – TrustYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement - TrustYes
2016: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedYes
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – TrustYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement - TrustYes
2015: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedYes
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – TrustYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement - TrustYes
2014: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedYes
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – TrustYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement - TrustYes
2013: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedYes
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – TrustYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement - TrustYes
2012: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedYes
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan funding arrangement – TrustYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement - TrustYes
2011: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedYes
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan funding arrangement – TrustYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement - TrustYes
2010: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01Submission has been amendedYes
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan funding arrangement – TrustYes
2010-05-01Plan benefit arrangement – InsuranceYes
2010-05-01Plan benefit arrangement - TrustYes
2009: SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedYes
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan funding arrangement – TrustYes
2009-05-01Plan benefit arrangement – InsuranceYes
2009-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered36
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $1,217
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $6,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,217
Amount paid for insurance broker fees0
Insurance broker organization code?4
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL159226
Policy instance 8
Insurance contract or identification numberGL159226
Number of Individuals Covered2115
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $56,506
Total amount of fees paid to insurance companyUSD $9,170
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $706,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,506
Amount paid for insurance broker fees9170
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1541069
Policy instance 7
Insurance contract or identification number1541069
Number of Individuals Covered2501
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $4,246
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $38,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,246
Amount paid for insurance broker fees0
Insurance broker organization code?3
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberNS0025-000
Policy instance 6
Insurance contract or identification numberNS0025-000
Number of Individuals Covered1676
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCHIROPRACTIC/ACUPUNTURE
Welfare Benefit Premiums Paid to CarrierUSD $47,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10000831001
Policy instance 5
Insurance contract or identification number10000831001
Number of Individuals Covered3444
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $22,170
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $189,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,170
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 3
Insurance contract or identification numberE3200706
Number of Individuals Covered384
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $44,314
Total amount of fees paid to insurance companyUSD $1,097
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $477,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,311
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 2
Insurance contract or identification number324
Number of Individuals Covered1272
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $64,867
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,162,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,867
Amount paid for insurance broker fees0
Insurance broker organization code?3
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number1001876
Policy instance 1
Insurance contract or identification number1001876
Number of Individuals Covered2575
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,346,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 2
Insurance contract or identification number324
Number of Individuals Covered1158
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $60,905
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,030,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $60,905
Amount paid for insurance broker fees0
Insurance broker organization code?3
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number1001876
Policy instance 1
Insurance contract or identification number1001876
Number of Individuals Covered2186
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,137,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 3
Insurance contract or identification numberE3200706
Number of Individuals Covered397
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $35,080
Total amount of fees paid to insurance companyUSD $594
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $411,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,749
Amount paid for insurance broker fees265
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10000831001
Policy instance 5
Insurance contract or identification number10000831001
Number of Individuals Covered3094
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $16,962
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $187,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,962
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNS0025-000
Policy instance 6
Insurance contract or identification numberNS0025-000
Number of Individuals Covered1452
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCHIROPRACTIC/ACUPUNTURE
Welfare Benefit Premiums Paid to CarrierUSD $38,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL159226
Policy instance 7
Insurance contract or identification numberGL159226
Number of Individuals Covered1878
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $40,276
Total amount of fees paid to insurance companyUSD $8,751
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $503,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,276
Amount paid for insurance broker fees8751
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered25
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $744
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $4,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $744
Amount paid for insurance broker fees0
Insurance broker organization code?4
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 2
Insurance contract or identification number324
Number of Individuals Covered1191
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $53,499
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $178,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $53,499
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 3
Insurance contract or identification numberE3200706
Number of Individuals Covered427
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $70,733
Total amount of fees paid to insurance companyUSD $2,870
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $264,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,843
Amount paid for insurance broker fees1019
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number1001876
Policy instance 1
Insurance contract or identification number1001876
Number of Individuals Covered1327
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,498,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL159226
Policy instance 8
Insurance contract or identification numberGL159226
Number of Individuals Covered1563
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $37,325
Total amount of fees paid to insurance companyUSD $7,063
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $466,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,325
Amount paid for insurance broker fees7063
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10000831001
Policy instance 5
Insurance contract or identification number10000831001
Number of Individuals Covered2741
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $15,897
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $160,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,897
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberSYHC
Policy instance 7
Insurance contract or identification numberSYHC
Number of Individuals Covered1333
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNS0025-000
Policy instance 6
Insurance contract or identification numberNS0025-000
Number of Individuals Covered1173
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCHIROPRACTIC/ACUPUNTURE
Welfare Benefit Premiums Paid to CarrierUSD $30,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered25
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $916
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $4,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $916
Amount paid for insurance broker fees0
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 1
Insurance contract or identification number228316
Number of Individuals Covered1361
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,754,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Number of Individuals Covered445
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $68,836
Total amount of fees paid to insurance companyUSD $3,142
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $522,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,527
Amount paid for insurance broker fees580
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number0009136625-B
Policy instance 3
Insurance contract or identification number0009136625-B
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $75
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159226
Policy instance 4
Insurance contract or identification numberGL 159226
Number of Individuals Covered1268
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $9,220
Total amount of fees paid to insurance companyUSD $2,281
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,220
Amount paid for insurance broker fees2281
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 129904
Policy instance 5
Insurance contract or identification numberLTD 129904
Number of Individuals Covered1268
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $18,286
Total amount of fees paid to insurance companyUSD $4,538
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $228,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,286
Amount paid for insurance broker fees4538
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberNS0025*000
Policy instance 10
Insurance contract or identification numberNS0025*000
Number of Individuals Covered993
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number1001876
Policy instance 1
Insurance contract or identification number1001876
Number of Individuals Covered1568
Total amount of commissions paid to insurance brokerUSD $178,613
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,953,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $178,613
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10000831001
Policy instance 9
Insurance contract or identification number10000831001
Number of Individuals Covered2410
Total amount of commissions paid to insurance brokerUSD $14,584
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $147,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,584
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 8
Insurance contract or identification number9324
Number of Individuals Covered2
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Other welfare benefits providedPREPAID MEDICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 7
Insurance contract or identification number324
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $50,112
Other welfare benefits providedPREPAID MEDICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Number of Individuals Covered1123
Commission paid to Insurance BrokerUSD $50,112
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 6
Insurance contract or identification number102507
Number of Individuals Covered17
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $193
Other welfare benefits providedLEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to CarrierUSD $4,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $193
Insurance broker organization code?4
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered17
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $725
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $725
Amount paid for insurance broker fees0
Insurance broker organization code?4
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number0009136625-B
Policy instance 3
Insurance contract or identification number0009136625-B
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $75
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75
Insurance broker organization code?3
Number of Individuals Covered1025
Total amount of fees paid to insurance companyUSD $0
Amount paid for insurance broker fees0
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159226
Policy instance 4
Insurance contract or identification numberGL 159226
Number of Individuals Covered1194
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $6,825
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,825
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 129904
Policy instance 5
Insurance contract or identification numberLTD 129904
Number of Individuals Covered1194
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $13,562
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,562
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 6
Insurance contract or identification number102507
Number of Individuals Covered17
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $725
Other welfare benefits providedLEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to CarrierUSD $3,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $725
Insurance broker organization code?4
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 7
Insurance contract or identification number324
Number of Individuals Covered1029
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $42,185
Other welfare benefits providedPREPAID MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $1,406,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,185
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD129904
Policy instance 5
Insurance contract or identification numberLTD129904
Number of Individuals Covered1194
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $13,562
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,562
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 8
Insurance contract or identification number9324
Number of Individuals Covered4
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Other welfare benefits providedPREPAID MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $4,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL159226
Policy instance 6
Insurance contract or identification numberGL159226
Number of Individuals Covered1194
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $6,825
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $85,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,825
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 7
Insurance contract or identification number9324
Number of Individuals Covered4
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10000831001
Policy instance 9
Insurance contract or identification number10000831001
Number of Individuals Covered2024
Total amount of commissions paid to insurance brokerUSD $11,449
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,383
Insurance broker organization code?3
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of fees paid to insurance companyUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBONUS
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 1
Insurance contract or identification number228316
Number of Individuals Covered1361
Total amount of commissions paid to insurance brokerUSD $142,650
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,754,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $142,650
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Number of Individuals Covered405
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $64,841
Total amount of fees paid to insurance companyUSD $5,731
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $421,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,124
Amount paid for insurance broker fees2361
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 8
Insurance contract or identification number324
Number of Individuals Covered1029
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $42,185
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,406,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,185
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered1361
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $142,650
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,754,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $142,650
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered405
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $64,841
Total amount of fees paid to insurance companyUSD $5,731
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $421,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,124
Amount paid for insurance broker fees2361
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 8
Insurance contract or identification number324
Number of Individuals Covered1026
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $47,318
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,577,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,318
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 6
Insurance contract or identification number649688
Number of Individuals Covered1177
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $4,083
Total amount of fees paid to insurance companyUSD $1,030
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,083
Amount paid for insurance broker fees1030
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered17
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $782
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $753
Amount paid for insurance broker fees0
Insurance broker organization code?4
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 7
Insurance contract or identification number9324
Number of Individuals Covered2
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,629
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 number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered1257
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $139,891
Total amount of fees paid to insurance companyUSD $11,608
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,674,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $139,891
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered397
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $117,693
Total amount of fees paid to insurance companyUSD $23,468
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $414,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,003
Amount paid for insurance broker fees12556
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 7
Insurance contract or identification number324
Number of Individuals Covered1026
Total amount of commissions paid to insurance brokerUSD $47,318
Other welfare benefits providedPREPAID MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $1,577,280
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 number228316
Policy instance 1
Insurance contract or identification number228316
Number of Individuals Covered1257
Total amount of commissions paid to insurance brokerUSD $139,891
Total amount of fees paid to insurance companyUSD $11,608
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,674,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 8
Insurance contract or identification number9324
Number of Individuals Covered2
Welfare Benefit Premiums Paid to CarrierUSD $5,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10000831001
Policy instance 9
Insurance contract or identification number10000831001
Number of Individuals Covered1944
Total amount of commissions paid to insurance brokerUSD $12,034
Welfare Benefit Premiums Paid to CarrierUSD $120,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $12,034
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 6
Insurance contract or identification number102507
Number of Individuals Covered17
Total amount of commissions paid to insurance brokerUSD $782
Other welfare benefits providedLEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to CarrierUSD $3,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 5
Insurance contract or identification number649688
Number of Individuals Covered1177
Total amount of commissions paid to insurance brokerUSD $6,048
Total amount of fees paid to insurance companyUSD $2,113
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Commission paid to Insurance BrokerUSD $6,048
Amount paid for insurance broker fees2113
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 4
Insurance contract or identification number649688
Number of Individuals Covered1177
Total amount of commissions paid to insurance brokerUSD $4,083
Total amount of fees paid to insurance companyUSD $1,030
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number0009136625-B
Policy instance 3
Insurance contract or identification number0009136625-B
Number of Individuals Covered2
Total amount of commissions paid to insurance brokerUSD $101
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of fees paid to insurance companyUSD $0
Commission paid to Insurance BrokerUSD $101
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Number of Individuals Covered397
Total amount of commissions paid to insurance brokerUSD $117,693
Total amount of fees paid to insurance companyUSD $23,468
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $414,590
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 number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered1136
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $169,663
Total amount of fees paid to insurance companyUSD $12,757
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,671,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $140,477
Amount paid for insurance broker fees12757
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered17
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $1,051
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $942
Amount paid for insurance broker fees0
Insurance broker organization code?4
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 5
Insurance contract or identification number649688
Number of Individuals Covered1122
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $5,927
Total amount of fees paid to insurance companyUSD $5,801
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,927
Amount paid for insurance broker fees5801
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 6
Insurance contract or identification number649688
Number of Individuals Covered1122
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $3,930
Total amount of fees paid to insurance companyUSD $3,181
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,930
Amount paid for insurance broker fees3181
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 7
Insurance contract or identification number9324
Number of Individuals Covered11
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 8
Insurance contract or identification number324
Number of Individuals Covered1014
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $68,901
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,378,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,901
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered267
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $24,665
Total amount of fees paid to insurance companyUSD $3,199
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $185,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,076
Amount paid for insurance broker fees1957
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 3
Insurance contract or identification number7008385
Number of Individuals Covered212
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $17,453
Total amount of fees paid to insurance companyUSD $6,391
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,366
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerCLAIMS ADMINISTRATIVE SERVICES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1000083
Policy instance 9
Insurance contract or identification number1000083
Number of Individuals Covered1823
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $10,424
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,424
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered1011
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $157,125
Total amount of fees paid to insurance companyUSD $1,829
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $157,125
Amount paid for insurance broker fees1829
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered241
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $12,548
Total amount of fees paid to insurance companyUSD $1,357
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $172,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,746
Amount paid for insurance broker fees1243
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 6
Insurance contract or identification number649688
Number of Individuals Covered1019
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $4,387
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,387
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 7
Insurance contract or identification number9324
Number of Individuals Covered3
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 8
Insurance contract or identification number324
Number of Individuals Covered948
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $62,572
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,251,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,572
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 3
Insurance contract or identification number7008385
Number of Individuals Covered187
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $23,226
Total amount of fees paid to insurance companyUSD $6,140
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,537
Insurance broker organization code?3
Amount paid for insurance broker fees4331
Additional information about fees paid to insurance brokerCLAIMS ADMINISTRATIVE SERVICES
Insurance broker nameCOBB BENEFITS GROUP LLC
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered21
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $927
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $100
Amount paid for insurance broker fees0
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 1
Insurance contract or identification number228316
Number of Individuals Covered1011
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $157,125
Total amount of fees paid to insurance companyUSD $1,829
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $157,125
Amount paid for insurance broker fees1829
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY LLC
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 6
Insurance contract or identification number102507
Number of Individuals Covered21
Total amount of commissions paid to insurance brokerUSD $927
Other welfare benefits providedPREPAID LEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $786
Insurance broker organization code?4
Insurance broker nameJAZMIN S STEELE
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 5
Insurance contract or identification number649688
Number of Individuals Covered1019
Total amount of commissions paid to insurance brokerUSD $6,993
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,993
Insurance broker organization code?3
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of fees paid to insurance companyUSD $0
Amount paid for insurance broker fees0
Insurance broker nameMARSH & MCLENNAN AGENCY INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 4
Insurance contract or identification number649688
Number of Individuals Covered1019
Total amount of commissions paid to insurance brokerUSD $4,387
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,387
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY LLC
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 7
Insurance contract or identification number324
Number of Individuals Covered948
Insurance policy start date2015-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $62,572
Other welfare benefits providedPREPAID MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $1,251,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,572
Insurance broker nameBARNEY AND BARNEY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Number of Individuals Covered241
Total amount of commissions paid to insurance brokerUSD $12,598
Total amount of fees paid to insurance companyUSD $1,357
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $172,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,746
Amount paid for insurance broker fees1243
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameCHRISTINA D POLK INC.
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 8
Insurance contract or identification number9324
Number of Individuals Covered3
Welfare Benefit Premiums Paid to CarrierUSD $4,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1000083
Policy instance 9
Insurance contract or identification number1000083
Number of Individuals Covered1650
Total amount of commissions paid to insurance brokerUSD $9,221
Welfare Benefit Premiums Paid to CarrierUSD $92,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,221
Insurance broker organization code?3
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Amount paid for insurance broker fees0
Insurance broker nameMARSH & MCLELLAN AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 6
Insurance contract or identification number649688
Number of Individuals Covered922
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $3,818
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,818
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered860
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $126,766
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,699,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $116,693
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered266
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $13,591
Total amount of fees paid to insurance companyUSD $834
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,108
Amount paid for insurance broker fees601
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 4
Insurance contract or identification number102507
Number of Individuals Covered12
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $216
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $164
Amount paid for insurance broker fees0
Insurance broker organization code?4
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 7
Insurance contract or identification number9324
Number of Individuals Covered3
Other welfare benefits providedPREPAID MEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $3,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 1
Insurance contract or identification number228316
Number of Individuals Covered860
Total amount of commissions paid to insurance brokerUSD $126,766
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,699,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $116,693
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 4
Insurance contract or identification number649688
Number of Individuals Covered922
Total amount of commissions paid to insurance brokerUSD $3,818
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,818
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 3
Insurance contract or identification number7008385
Number of Individuals Covered194
Total amount of commissions paid to insurance brokerUSD $25,165
Total amount of fees paid to insurance companyUSD $5,785
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,630
Amount paid for insurance broker fees228
Additional information about fees paid to insurance brokerMARKETING FEE
Insurance broker organization code?3
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Insurance broker nameCOBB BENEFITS GROUP LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 5
Insurance contract or identification number649688
Number of Individuals Covered922
Total amount of commissions paid to insurance brokerUSD $5,430
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,430
Insurance broker organization code?3
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of fees paid to insurance companyUSD $0
Amount paid for insurance broker fees0
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 6
Insurance contract or identification number102507
Number of Individuals Covered12
Total amount of commissions paid to insurance brokerUSD $216
Other welfare benefits providedPREPAID LEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $164
Insurance broker organization code?4
Insurance broker nameANNETTE E WHITE INSURNACE SERV
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Number of Individuals Covered266
Total amount of commissions paid to insurance brokerUSD $13,591
Total amount of fees paid to insurance companyUSD $834
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,108
Amount paid for insurance broker fees601
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
Insurance broker organization code?3
Insurance broker nameMICHAEL FAHEY III
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 7
Insurance contract or identification number102507
Number of Individuals Covered11
Total amount of commissions paid to insurance brokerUSD $258
Other welfare benefits providedPREPAID LEGAL
Welfare Benefit Premiums Paid to CarrierUSD $2,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $202
Insurance broker organization code?4
Insurance broker nameANNETTE E WHITE INSURNACE SERV
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 3
Insurance contract or identification number324
Number of Individuals Covered723
Total amount of commissions paid to insurance brokerUSD $61,794
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,794
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 4
Insurance contract or identification number7008385
Number of Individuals Covered227
Total amount of commissions paid to insurance brokerUSD $12,526
Total amount of fees paid to insurance companyUSD $17,969
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11867
Additional information about fees paid to insurance brokerMARKETING FEE
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $8,514
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Welfare Benefit Premiums Paid to CarrierUSD $105,217
Insurance broker nameBARNEY & BARNEY LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 5
Insurance contract or identification number649688
Number of Individuals Covered794
Total amount of commissions paid to insurance brokerUSD $3,605
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,200
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 6
Insurance contract or identification number649688
Number of Individuals Covered794
Total amount of commissions paid to insurance brokerUSD $5,369
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,023
Insurance broker organization code?3
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of fees paid to insurance companyUSD $0
Amount paid for insurance broker fees0
Insurance broker nameBARNEY & BARNEY
SIMNSA (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9324
Policy instance 8
Insurance contract or identification number9324
Number of Individuals Covered5
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9324
Policy instance 8
Insurance contract or identification number9324
Number of Individuals Covered5
Other welfare benefits providedPREPAID MEDICAL
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 number228316
Policy instance 1
Insurance contract or identification number228316
Number of Individuals Covered712
Total amount of commissions paid to insurance brokerUSD $115,693
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,535
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered279
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $17,913
Total amount of fees paid to insurance companyUSD $1,687
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $190,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,493
Amount paid for insurance broker fees875
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered712
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $115,693
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,311,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,535
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number324
Policy instance 3
Insurance contract or identification number324
Number of Individuals Covered723
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $61,794
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $882,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,794
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 5
Insurance contract or identification number102507
Number of Individuals Covered11
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $258
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $2,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $202
Amount paid for insurance broker fees0
Insurance broker organization code?4
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 7
Insurance contract or identification number649688
Number of Individuals Covered794
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $3,605
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,200
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Number of Individuals Covered279
Total amount of commissions paid to insurance brokerUSD $17,913
Total amount of fees paid to insurance companyUSD $1,687
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,493
Amount paid for insurance broker fees875
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
Insurance broker organization code?3
Insurance broker nameMICHAEL FAHEY III
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 7
Insurance contract or identification number649688
Number of Individuals Covered775
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $4,972
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,972
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 7
Insurance contract or identification number228316
Number of Individuals Covered671
Total amount of commissions paid to insurance brokerUSD $108,008
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $108,008
Insurance broker organization code?3
Insurance broker nameKINGSROAD FINANCIAL INSURANCE
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 6
Insurance contract or identification numberE3200706
Number of Individuals Covered334
Total amount of commissions paid to insurance brokerUSD $66,144
Total amount of fees paid to insurance companyUSD $5,932
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2
Insurance broker organization code?3
Amount paid for insurance broker fees1
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
Insurance broker nameKINGSROAD FINANCIAL INSURANCE SERV
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 5
Insurance contract or identification number324
Number of Individuals Covered676
Total amount of commissions paid to insurance brokerUSD $63,240
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,240
Insurance broker organization code?3
Insurance broker nameKINGSROAD FINANCIAL INSURANCE
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 6
Insurance contract or identification number649688
Number of Individuals Covered775
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $8,170
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,170
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 5
Insurance contract or identification number102507
Number of Individuals Covered10
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $363
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $2,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $151
Amount paid for insurance broker fees0
Insurance broker organization code?4
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 3
Insurance contract or identification number324
Number of Individuals Covered676
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $63,240
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $903,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,240
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 2
Insurance contract or identification number228316
Number of Individuals Covered671
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $108,008
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,881,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $108,008
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered334
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $66,144
Total amount of fees paid to insurance companyUSD $5,932
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,197
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 2
Insurance contract or identification number649688
Number of Individuals Covered775
Total amount of commissions paid to insurance brokerUSD $8,170
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,170
Insurance broker nameKINGSROAD FINANCIAL INSURANCE SRVCS
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649688
Policy instance 3
Insurance contract or identification number649688
Number of Individuals Covered775
Total amount of commissions paid to insurance brokerUSD $4,972
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,972
Insurance broker organization code?3
Insurance broker nameKINGSROAD FINANCIAL INSURANCE SERV
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 4
Insurance contract or identification number7008385
Number of Individuals Covered241
Total amount of commissions paid to insurance brokerUSD $15,050
Total amount of fees paid to insurance companyUSD $20,868
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees743
Additional information about fees paid to insurance brokerMARKETING FEE
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,051
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Welfare Benefit Premiums Paid to CarrierUSD $112,400
Insurance broker nameSCOTT CASTEEL
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number102507
Policy instance 1
Insurance contract or identification number102507
Number of Individuals Covered10
Total amount of commissions paid to insurance brokerUSD $363
Other welfare benefits providedPREPAID LEGAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63
Insurance broker organization code?4
Insurance broker nameDAVID QUACKENBUSH
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 5
Insurance contract or identification number7008385
Number of Individuals Covered249
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $62,478
Total amount of fees paid to insurance companyUSD $11,244
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,517
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerCLAIMS ADINISTRATIVE SERVICES
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number7008385
Policy instance 1
Insurance contract or identification number7008385
Number of Individuals Covered249
Total amount of commissions paid to insurance brokerUSD $62,478
Total amount of fees paid to insurance companyUSD $11,244
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 2
Insurance contract or identification number324
Number of Individuals Covered634
Total amount of commissions paid to insurance brokerUSD $51,345
Health Insurance Welfare BenefitYes
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 number228316
Policy instance 5
Insurance contract or identification number228316
Number of Individuals Covered584
Total amount of commissions paid to insurance brokerUSD $95,552
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091336
Policy instance 4
Insurance contract or identification number091336
Number of Individuals Covered703
Total amount of commissions paid to insurance brokerUSD $9,281
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 3
Insurance contract or identification numberE3200706
Number of Individuals Covered268
Total amount of commissions paid to insurance brokerUSD $47,864
Total amount of fees paid to insurance companyUSD $4,800
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered268
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $47,864
Total amount of fees paid to insurance companyUSD $4,800
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $182,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,440
Amount paid for insurance broker fees2556
Additional information about fees paid to insurance brokerPROFIT SHARING FEE
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091336
Policy instance 2
Insurance contract or identification number091336
Number of Individuals Covered703
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $9,281
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $182,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,281
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 3
Insurance contract or identification number228316
Number of Individuals Covered584
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $95,552
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,470,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,552
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 4
Insurance contract or identification number324
Number of Individuals Covered634
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $51,345
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $733,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,345
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 4
Insurance contract or identification number324
Number of Individuals Covered540
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $38,074
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $543,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,074
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091336
Policy instance 2
Insurance contract or identification number091336
Number of Individuals Covered632
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $9,135
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,135
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered583
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $67,390
Total amount of fees paid to insurance companyUSD $4,071
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $309,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,723
Amount paid for insurance broker fees1664
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number228316
Policy instance 3
Insurance contract or identification number228316
Number of Individuals Covered535
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $62,398
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,024,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,398
Amount paid for insurance broker fees0
Insurance broker organization code?3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number324
Policy instance 1
Insurance contract or identification number324
Number of Individuals Covered540
Total amount of commissions paid to insurance brokerUSD $38,074
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 2
Insurance contract or identification numberE3200706
Total amount of commissions paid to insurance brokerUSD $67,390
Total amount of fees paid to insurance companyUSD $4,071
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091336
Policy instance 3
Insurance contract or identification number091336
Number of Individuals Covered632
Total amount of commissions paid to insurance brokerUSD $9,135
Life Insurance Welfare BenefitYes
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 number228316
Policy instance 4
Insurance contract or identification number228316
Number of Individuals Covered535
Total amount of commissions paid to insurance brokerUSD $62,398
Health Insurance Welfare BenefitYes
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 number228316
Policy instance 3
Insurance contract or identification number228316
Number of Individuals Covered534
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $64,125
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,857,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,125
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3200706
Policy instance 1
Insurance contract or identification numberE3200706
Number of Individuals Covered584
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $80,247
Total amount of fees paid to insurance companyUSD $14,395
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $261,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $22,081
Amount paid for insurance broker fees6685
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091336
Policy instance 2
Insurance contract or identification number091336
Number of Individuals Covered602
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $10,314
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $192,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,314
Amount paid for insurance broker fees0
Insurance broker organization code?3

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