401k Plan data: THE BRAUER GROUP II - FLEX BENEFIT PLAN plan

THE BRAUER GROUP II - FLEX BENEFIT PLAN 401k Plan overview

Plan Name	THE BRAUER GROUP II - FLEX BENEFIT PLAN
Plan identification number	503

THE BRAUER GROUP II - FLEX BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

THE BRAUER GROUP II, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE BRAUER GROUP II, INC.

Employer identification number (EIN): 454101163

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE BRAUER GROUP II - FLEX BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01 H JONATHAN BRAUER 2023-10-06
503 2021-01-01 H JONATHAN BRAUER 2022-07-08
503 2020-01-01 H JONATHAN BRAUER 2021-10-08
503 2019-01-01
503 2018-01-01
503 2017-01-01 JONATHAN BRAUER
503 2016-01-01 JONATHAN BRAUER
503 2015-01-01 JONATHAN BRAUER JONATHAN BRAUER 2016-09-19
503 2014-01-01 H JONATHAN BRAUER H JONATHAN BRAUER 2015-09-11
503 2013-01-01 H JONATHAN BRAUER H JONATHAN BRAUER 2014-07-10
503 2012-01-01 H JONATHAN BRAUER H JONATHAN BRAUER 2013-10-11

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01		H JONATHAN BRAUER	2023-10-06
503	2021-01-01		H JONATHAN BRAUER	2022-07-08
503	2020-01-01		H JONATHAN BRAUER	2021-10-08
503	2019-01-01
503	2018-01-01
503	2017-01-01	JONATHAN BRAUER
503	2016-01-01	JONATHAN BRAUER
503	2015-01-01	JONATHAN BRAUER	JONATHAN BRAUER	2016-09-19
503	2014-01-01	H JONATHAN BRAUER	H JONATHAN BRAUER	2015-09-11
503	2013-01-01	H JONATHAN BRAUER	H JONATHAN BRAUER	2014-07-10
503	2012-01-01	H JONATHAN BRAUER	H JONATHAN BRAUER	2013-10-11

Plan Statistics for THE BRAUER GROUP II - FLEX BENEFIT PLAN

401k plan membership statisitcs for THE BRAUER GROUP II - FLEX BENEFIT PLAN

Measure Date Value
2022: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 190
Total of all active and inactive participants 2022-01-01 190
Total participants 2022-01-01 190
2021: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 170
Total of all active and inactive participants 2021-01-01 170
Total participants 2021-01-01 170
2020: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 169
Total of all active and inactive participants 2020-01-01 169
Total participants 2020-01-01 169
2019: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 199
Total of all active and inactive participants 2019-01-01 199
Total participants 2019-01-01 199
2018: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 194
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 191
Total of all active and inactive participants 2018-01-01 191
Total participants 2018-01-01 191
2017: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 194
Total of all active and inactive participants 2017-01-01 194
Total participants 2017-01-01 194
2016: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 176
Total of all active and inactive participants 2016-01-01 176
Total participants 2016-01-01 176
2015: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 175
Total of all active and inactive participants 2015-01-01 175
Total participants 2015-01-01 175
2014: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 173
Number of retired or separated participants receiving benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 173
2013: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 154
Number of retired or separated participants receiving benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 156
2012: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 186
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 161
Number of retired or separated participants receiving benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 163

Measure	Date	Value
2022: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	190
Total of all active and inactive participants	2022-01-01	190
Total participants	2022-01-01	190
2021: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	170
Total of all active and inactive participants	2021-01-01	170
Total participants	2021-01-01	170
2020: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	169
Total of all active and inactive participants	2020-01-01	169
Total participants	2020-01-01	169
2019: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	199
Total of all active and inactive participants	2019-01-01	199
Total participants	2019-01-01	199
2018: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	194
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	191
Total of all active and inactive participants	2018-01-01	191
Total participants	2018-01-01	191
2017: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	194
Total of all active and inactive participants	2017-01-01	194
Total participants	2017-01-01	194
2016: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	176
Total of all active and inactive participants	2016-01-01	176
Total participants	2016-01-01	176
2015: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	175
Total of all active and inactive participants	2015-01-01	175
Total participants	2015-01-01	175
2014: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	173
Number of retired or separated participants receiving benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	173
2013: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	154
Number of retired or separated participants receiving benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	156
2012: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	186
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	161
Number of retired or separated participants receiving benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	163

Form 5500 Responses for THE BRAUER GROUP II - FLEX BENEFIT PLAN

2022: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: THE BRAUER GROUP II - FLEX BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )

Policy contract number

20032509

Policy instance

Insurance contract or identification number	20032509
Number of Individuals Covered	62
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,028
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $160,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,028
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	79
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $457
Total amount of fees paid to insurance company	USD $323
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $457
Insurance broker organization code?	3
Amount paid for insurance broker fees	228
Additional information about fees paid to insurance broker	BONUS PAID

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	92
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,264
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,264
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

541431

Policy instance

Insurance contract or identification number	541431
Number of Individuals Covered	47
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $807
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $538
Insurance broker organization code?	3

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	62
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,674
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $234,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,674
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

05949331

Policy instance

Insurance contract or identification number	05949331
Number of Individuals Covered	108
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,104
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,235
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

6F4508

Policy instance

Insurance contract or identification number	6F4508
Number of Individuals Covered	57
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $517
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $517
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0264258

Policy instance

Insurance contract or identification number	0264258
Number of Individuals Covered	83
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $42,759
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $738,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,946
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

411288T

Policy instance

Insurance contract or identification number	411288T
Number of Individuals Covered	133
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,818
Total amount of fees paid to insurance company	USD $721
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	231
Additional information about fees paid to insurance broker	BONUS PAID
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,895

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	103
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,603
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,603
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

541431

Policy instance

Insurance contract or identification number	541431
Number of Individuals Covered	50
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $788
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $525
Insurance broker organization code?	3

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	61
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $20,001
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $371,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,001
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

05949331

Policy instance

Insurance contract or identification number	05949331
Number of Individuals Covered	105
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,070
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $31,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,070
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

6F4508

Policy instance

Insurance contract or identification number	6F4508
Number of Individuals Covered	60
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $529
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $529
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0264258

Policy instance

Insurance contract or identification number	0264258
Number of Individuals Covered	93
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $40,130
Welfare Benefit Premiums Paid to Carrier	USD $764,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,048
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	81
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $503
Total amount of fees paid to insurance company	USD $252
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $503
Insurance broker organization code?	3
Amount paid for insurance broker fees	252

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

411288T

Policy instance

Insurance contract or identification number	411288T
Number of Individuals Covered	123
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,480
Total amount of fees paid to insurance company	USD $2,011
Welfare Benefit Premiums Paid to Carrier	USD $34,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,480
Amount paid for insurance broker fees	287
Additional information about fees paid to insurance broker	BONUS PAID
Insurance broker organization code?	3

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	110
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,132
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,132
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	78
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $446
Total amount of fees paid to insurance company	USD $223
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $446
Insurance broker organization code?	3
Amount paid for insurance broker fees	223

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

411288T

Policy instance

Insurance contract or identification number	411288T
Number of Individuals Covered	125
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,715
Total amount of fees paid to insurance company	USD $1,865
Welfare Benefit Premiums Paid to Carrier	USD $37,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,715
Insurance broker organization code?	3
Amount paid for insurance broker fees	1865

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

541431

Policy instance

Insurance contract or identification number	541431
Number of Individuals Covered	51
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $814
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $543
Insurance broker organization code?	3

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	62
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15,418
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,418
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

05949331

Policy instance

Insurance contract or identification number	05949331
Number of Individuals Covered	103
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $2,287
Total amount of fees paid to insurance company	USD $1,015
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $31,389
Commission paid to Insurance Broker	USD $2,287
Amount paid for insurance broker fees	1015
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

6F4508

Policy instance

Insurance contract or identification number	6F4508
Number of Individuals Covered	62
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $644
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $644
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0264258

Policy instance

Insurance contract or identification number	0264258
Number of Individuals Covered	99
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,421
Welfare Benefit Premiums Paid to Carrier	USD $439,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,421
Insurance broker organization code?	3

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

BG9654

Policy instance

Insurance contract or identification number	BG9654
Number of Individuals Covered	97
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $34,540
Total amount of fees paid to insurance company	USD $1,403
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $730,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,540
Amount paid for insurance broker fees	1403
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	82
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $791
Total amount of fees paid to insurance company	USD $59
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	59
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $557

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	67
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $26,366
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $496,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,366
Insurance broker organization code?	3

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	66
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $18,819
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $345,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,819
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05949331

Policy instance

Insurance contract or identification number	TM05949331
Number of Individuals Covered	108
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,150
Total amount of fees paid to insurance company	USD $78
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $33,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,150
Amount paid for insurance broker fees	78
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

6F4508

Policy instance

Insurance contract or identification number	6F4508
Number of Individuals Covered	49
Insurance policy start date	2019-06-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $242
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $242
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

541431

Policy instance

Insurance contract or identification number	541431
Number of Individuals Covered	59
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $867
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $578
Insurance broker organization code?	3

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	113
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,432
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,432
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	83
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $566
Total amount of fees paid to insurance company	USD $61
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	61
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $566

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	109
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,297
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,297
Insurance broker organization code?	3

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	66
Insurance policy start date	2018-08-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,833
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,833
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05949331

Policy instance

Insurance contract or identification number	TM05949331
Number of Individuals Covered	111
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,083
Total amount of fees paid to insurance company	USD $876
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $33,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,083
Amount paid for insurance broker fees	876
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	69
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $18,482
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $400,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,482
Insurance broker organization code?	3

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

BG9654

Policy instance

Insurance contract or identification number	BG9654
Number of Individuals Covered	98
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $30,362
Total amount of fees paid to insurance company	USD $348
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $649,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,362
Amount paid for insurance broker fees	348
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

541431

Policy instance

Insurance contract or identification number	541431
Number of Individuals Covered	55
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $639
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $213
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	95
Insurance policy start date	2016-06-01
Insurance policy end date	2017-05-31
Total amount of commissions paid to insurance broker	USD $475
Total amount of fees paid to insurance company	USD $1,833
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	85
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $475
Insurance broker name	MARSH AND MCLENNAN AGENCY LLC

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

BG9654

Policy instance

Insurance contract or identification number	BG9654
Number of Individuals Covered	89
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $31,915
Total amount of fees paid to insurance company	USD $1,944
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $670,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,915
Amount paid for insurance broker fees	1944
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH AND MCLENNAN AGENCY LLC

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	61
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,829
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,829
Insurance broker organization code?	3
Insurance broker name	MARSH AND MCLENNAN AGENCY LLC

HEALTHNOW NEW YORK INC. (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

56-9847

Policy instance

Insurance contract or identification number	56-9847
Number of Individuals Covered	54
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

PRESTIGEAU

Policy instance

Insurance contract or identification number	PRESTIGEAU
Number of Individuals Covered	54
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,062
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,062
Insurance broker organization code?	3
Insurance broker name	FNA INSURANCE SERVICES, INC

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

490157

Policy instance

Insurance contract or identification number	490157
Number of Individuals Covered	72
Insurance policy start date	2017-08-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,013
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $150,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,013
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )

Policy contract number

200031098

Policy instance

Insurance contract or identification number	200031098
Number of Individuals Covered	75
Insurance policy start date	2017-01-01
Insurance policy end date	2017-07-31
Total amount of commissions paid to insurance broker	USD $10,689
Welfare Benefit Premiums Paid to Carrier	USD $212,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,689
Insurance broker name	MARSHALL AND STERLING INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	90
Insurance policy start date	2015-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $151
Total amount of fees paid to insurance company	USD $100
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,462
Commission paid to Insurance Broker	USD $151
Insurance broker organization code?	3
Amount paid for insurance broker fees	100
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	MARSH & MACLENNAN AGENCY LLC

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

BG9654

Policy instance

Insurance contract or identification number	BG9654
Number of Individuals Covered	96
Insurance policy start date	2015-06-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,792
Total amount of fees paid to insurance company	USD $718
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $14,792
Amount paid for insurance broker fees	718
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH AND MCLENNAN AGENCY LLC

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03416

Policy instance

Insurance contract or identification number	03416
Number of Individuals Covered	53
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,986
Dental Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $1,986
Insurance broker organization code?	3
Insurance broker name	MARSH AND MCLENNAN AGENCY LLC

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

211211

Policy instance

Insurance contract or identification number	211211
Number of Individuals Covered	76
Insurance policy start date	2015-01-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $11,270
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $11,270
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING

HEALTHNOW NEW YORK INC. (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

56-9847

Policy instance

Insurance contract or identification number	56-9847
Number of Individuals Covered	49
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	54
Insurance policy start date	2015-01-01
Insurance policy end date	2015-05-31
Total amount of fees paid to insurance company	USD $7,480
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $211,440
Amount paid for insurance broker fees	7480
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	54
Insurance policy start date	2015-01-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $1,517
Welfare Benefit Premiums Paid to Carrier	USD $43,102
Commission paid to Insurance Broker	USD $1,517
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

GVNY7687

Policy instance

Insurance contract or identification number	GVNY7687
Number of Individuals Covered	49
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $490
Vision Insurance Welfare Benefit	Yes
Amount paid for insurance broker fees	490
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING INC

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )

Policy contract number

20031098

Policy instance

Insurance contract or identification number	20031098
Number of Individuals Covered	47
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,130
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,604
Commission paid to Insurance Broker	USD $7,130
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

3416

Policy instance

Insurance contract or identification number	3416
Number of Individuals Covered	54
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,157
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,157
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

GVNY7687

Policy instance

Insurance contract or identification number	GVNY7687
Number of Individuals Covered	49
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $544
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	544
Insurance broker organization code?	3
Insurance broker name	BRADLEY PALMITER

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	79
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $615
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $615
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	50
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,464
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $533,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,464
Insurance broker organization code?	3
Insurance broker name	THE NIA GROUP

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	50
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,725
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $106,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,725
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

211211

Policy instance

Insurance contract or identification number	211211
Number of Individuals Covered	89
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $20,378
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,378
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING

HEALTHNOW NEW YORK INC. (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

56-9847

Policy instance

Insurance contract or identification number	56-9847
Number of Individuals Covered	48
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

3416

Policy instance

Insurance contract or identification number	3416
Number of Individuals Covered	49
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,439
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,439
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

GVNY7687

Policy instance

Insurance contract or identification number	GVNY7687
Number of Individuals Covered	293
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $718
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $718
Insurance broker organization code?	3
Insurance broker name	BRADLEY PALMITER

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	75
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $511
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $511
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	50
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,780
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $563,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,780
Insurance broker organization code?	3
Insurance broker name	THE NIA GROUP

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	50
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,195
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $110,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,195
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

211211

Policy instance

Insurance contract or identification number	211211
Number of Individuals Covered	115
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $31,899
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,899
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING

HEALTHNOW NEW YORK INC. (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

56-9847

Policy instance

Insurance contract or identification number	56-9847
Number of Individuals Covered	81
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

GVNY7687

Policy instance

Insurance contract or identification number	GVNY7687
Number of Individuals Covered	64
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $729
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $729
Insurance broker organization code?	3
Insurance broker name	BRADLEY PALMITER

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

861508G

Policy instance

Insurance contract or identification number	861508G
Number of Individuals Covered	70
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $509
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $509
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

3416

Policy instance

Insurance contract or identification number	3416
Number of Individuals Covered	53
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,584
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,584
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY, LLC

MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 )

Policy contract number

211211

Policy instance

Insurance contract or identification number	211211
Number of Individuals Covered	124
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $31,790
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,790
Insurance broker organization code?	3
Insurance broker name	MARSHALL & STERLING

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	53
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,163
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $107,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,111
Insurance broker organization code?	3
Insurance broker name	THE NIA GROUP

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

89668

Policy instance

Insurance contract or identification number	89668
Number of Individuals Covered	53
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $21,277
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $533,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,132
Insurance broker organization code?	3
Insurance broker name	THE NIA GROUP

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Company Name:	THE BRAUER GROUP II, INC.
Employer identification number (EIN):	454101163
NAIC Classification:	441110
NAIC Description:	New Car Dealers