401k Plan data: FLORIDA EYE CLINIC CAFETERIA PLAN plan

FLORIDA EYE CLINIC CAFETERIA PLAN 401k Plan overview

Plan Name	FLORIDA EYE CLINIC CAFETERIA PLAN
Plan identification number	501

FLORIDA EYE CLINIC CAFETERIA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

FLORIDA EYE CLINIC, P.A. has sponsored the creation of one or more 401k plans.

Company Name: FLORIDA EYE CLINIC, P.A.

Employer identification number (EIN): 591493386

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FLORIDA EYE CLINIC CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-09-01 SONDRA HOFFMAN SONDRA HOFFMAN 2016-02-04
501 2013-09-01 SONDRA HOFFMAN SONDRA HOFFMAN 2015-06-15
501 2012-09-01 DR HARRY R PAPPAS DR HARRY R PAPPAS
501 2012-09-01 DR HARRY R PAPPAS DR HARRY R PAPPAS 2014-06-17
501 2011-09-01 JOHN ISLER JOHN ISLER 2013-02-05
501 2011-05-01 DR. HARRY R. PAPPAS
501 2009-05-01 BONNIE CAPELLO

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2014-09-01	SONDRA HOFFMAN	SONDRA HOFFMAN	2016-02-04
501	2013-09-01	SONDRA HOFFMAN	SONDRA HOFFMAN	2015-06-15
501	2012-09-01	DR HARRY R PAPPAS	DR HARRY R PAPPAS
501	2012-09-01	DR HARRY R PAPPAS	DR HARRY R PAPPAS	2014-06-17
501	2011-09-01	JOHN ISLER	JOHN ISLER	2013-02-05
501	2011-05-01	DR. HARRY R. PAPPAS
501	2009-05-01	BONNIE CAPELLO

Plan Statistics for FLORIDA EYE CLINIC CAFETERIA PLAN

401k plan membership statisitcs for FLORIDA EYE CLINIC CAFETERIA PLAN

Measure Date Value
2014: FLORIDA EYE CLINIC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 218
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 208
Number of retired or separated participants receiving benefits 2014-09-01 0
Number of other retired or separated participants entitled to future benefits 2014-09-01 0
Total of all active and inactive participants 2014-09-01 208
2013: FLORIDA EYE CLINIC CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 229
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 218
Total of all active and inactive participants 2013-09-01 218
2012: FLORIDA EYE CLINIC CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 211
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 229
Total of all active and inactive participants 2012-09-01 229
2011: FLORIDA EYE CLINIC CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 194
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 211
Number of retired or separated participants receiving benefits 2011-09-01 0
Number of other retired or separated participants entitled to future benefits 2011-09-01 0
Total of all active and inactive participants 2011-09-01 211
Total participants 2011-09-01 211
Total participants, beginning-of-year 2011-05-01 226
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 194
Number of retired or separated participants receiving benefits 2011-05-01 0
Total of all active and inactive participants 2011-05-01 194
Total participants 2011-05-01 194
2009: FLORIDA EYE CLINIC CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-05-01 218
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 202
Number of retired or separated participants receiving benefits 2009-05-01 0
Number of other retired or separated participants entitled to future benefits 2009-05-01 0
Total of all active and inactive participants 2009-05-01 202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-05-01 0
Total participants 2009-05-01 202
Number of participants with account balances 2009-05-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-05-01 0

Measure	Date	Value
2014: FLORIDA EYE CLINIC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	218
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	208
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	0
Total of all active and inactive participants	2014-09-01	208
2013: FLORIDA EYE CLINIC CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	229
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	218
Total of all active and inactive participants	2013-09-01	218
2012: FLORIDA EYE CLINIC CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	211
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	229
Total of all active and inactive participants	2012-09-01	229
2011: FLORIDA EYE CLINIC CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	194
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	211
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	0
Total of all active and inactive participants	2011-09-01	211
Total participants	2011-09-01	211
Total participants, beginning-of-year	2011-05-01	226
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	194
Number of retired or separated participants receiving benefits	2011-05-01	0
Total of all active and inactive participants	2011-05-01	194
Total participants	2011-05-01	194
2009: FLORIDA EYE CLINIC CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-05-01	218
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	202
Number of retired or separated participants receiving benefits	2009-05-01	0
Number of other retired or separated participants entitled to future benefits	2009-05-01	0
Total of all active and inactive participants	2009-05-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-05-01	0
Total participants	2009-05-01	202
Number of participants with account balances	2009-05-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-05-01	0

Form 5500 Responses for FLORIDA EYE CLINIC CAFETERIA PLAN

2014: FLORIDA EYE CLINIC CAFETERIA PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: FLORIDA EYE CLINIC CAFETERIA PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: FLORIDA EYE CLINIC CAFETERIA PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	Yes
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: FLORIDA EYE CLINIC CAFETERIA PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Submission has been amended	Yes
2011-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-05-01	Plan funding arrangement – Insurance	Yes
2011-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2011-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: FLORIDA EYE CLINIC CAFETERIA PLAN 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	Plan funding arrangement – Insurance	Yes
2009-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes
2009-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024791

Policy instance

Insurance contract or identification number	00001D024791
Number of Individuals Covered	58
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $2,871
Total amount of fees paid to insurance company	USD $1,683
Dental 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	1436
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,871
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010025972

Policy instance

Insurance contract or identification number	000010025972
Number of Individuals Covered	208
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $1,836
Total amount of fees paid to insurance company	USD $1,093
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	612
Additional information about fees paid to insurance broker	TPA FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,836
Insurance broker name	HYLANT GROUP INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050030000

Policy instance

Insurance contract or identification number	000010050030000
Number of Individuals Covered	10
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $381
Total amount of fees paid to insurance company	USD $217
Other welfare benefits provided	WEEKLY INCOME
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	127
Additional information about fees paid to insurance broker	TPA FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $381
Insurance broker name	HYLANT GROUP INC

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	16
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of fees paid to insurance company	USD $9,066
Health 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	9066
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024789000

Policy instance

Insurance contract or identification number	00001D024789000
Number of Individuals Covered	13
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $293
Total amount of fees paid to insurance company	USD $24
Other welfare benefits provided	DHMO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	24
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $293
Insurance broker name	HYLANT GROUP INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024790000

Policy instance

Insurance contract or identification number	00001D024790000
Number of Individuals Covered	37
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $3,143
Total amount of fees paid to insurance company	USD $1,890
Dental 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	1572
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,143
Insurance broker name	HYLANT GROUP INC.

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	109
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of fees paid to insurance company	USD $38,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	38155
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050029000

Policy instance

Insurance contract or identification number	000010050029000
Number of Individuals Covered	10
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $1,558
Total amount of fees paid to insurance company	USD $945
Long Term Disability 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	519
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,558
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010164745000

Policy instance

Insurance contract or identification number	000010164745000
Number of Individuals Covered	33
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $1,722
Total amount of fees paid to insurance company	USD $1,315
Long Term Disability 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	861
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,722
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400115521000

Policy instance

Insurance contract or identification number	000400115521000
Number of Individuals Covered	61
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $2,892
Total amount of fees paid to insurance company	USD $1,804
Other welfare benefits provided	VOLUNTARY LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	964
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,892
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010164746000

Policy instance

Insurance contract or identification number	000010164746000
Number of Individuals Covered	52
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $2,356
Total amount of fees paid to insurance company	USD $329
Other welfare benefits provided	WEEKLY INCOME
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $785
Insurance broker organization code?	3
Amount paid for insurance broker fees	329
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	HYLANT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050030000

Policy instance

Insurance contract or identification number	000010050030000
Number of Individuals Covered	12
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $357
Total amount of fees paid to insurance company	USD $119
Other welfare benefits provided	WEEKLY INCOME
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	119
Additional information about fees paid to insurance broker	TPA FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $357
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010164746000

Policy instance

Insurance contract or identification number	000010164746000
Number of Individuals Covered	53
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,476
Other welfare benefits provided	WEEKLY INCOME
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $826
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GORUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010164745000

Policy instance

Insurance contract or identification number	000010164745000
Number of Individuals Covered	31
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $1,681
Total amount of fees paid to insurance company	USD $841
Long Term Disability 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	841
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,681
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050029000

Policy instance

Insurance contract or identification number	000010050029000
Number of Individuals Covered	12
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $1,588
Total amount of fees paid to insurance company	USD $529
Long Term Disability 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	529
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,588
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024790000

Policy instance

Insurance contract or identification number	00001D024790000
Number of Individuals Covered	42
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,714
Total amount of fees paid to insurance company	USD $1,357
Dental 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	1357
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,714
Insurance broker name	HYLANT GROUP INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024789000

Policy instance

Insurance contract or identification number	00001D024789000
Number of Individuals Covered	16
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $202
Other welfare benefits provided	DHMO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $202
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC.

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	100
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of fees paid to insurance company	USD $27,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	27698
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	19
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of fees paid to insurance company	USD $11,079
Health 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	11079
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024791

Policy instance

Insurance contract or identification number	00001D024791
Number of Individuals Covered	109
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,357
Total amount of fees paid to insurance company	USD $1,307
Dental 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	129
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,357
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400115521000

Policy instance

Insurance contract or identification number	000400115521000
Number of Individuals Covered	61
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,992
Total amount of fees paid to insurance company	USD $997
Other welfare benefits provided	VOLUNTARY LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	997
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,992
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010025972

Policy instance

Insurance contract or identification number	000010025972
Number of Individuals Covered	218
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $1,825
Total amount of fees paid to insurance company	USD $783
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	175
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,825
Insurance broker name	HYLANT GROUP INC.

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	96
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $24,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,365
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	AGIS FLORIDA AGENCY LLC

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	16
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $10,329
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 $10,329
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	AGIS FLORIDA AGENCY, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010025972

Policy instance

Insurance contract or identification number	000010025972
Number of Individuals Covered	194
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,695
Total amount of fees paid to insurance company	USD $555
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $11,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $850
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	555
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024791

Policy instance

Insurance contract or identification number	00001D024791
Number of Individuals Covered	110
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,551
Total amount of fees paid to insurance company	USD $775
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $710
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	775
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400115521

Policy instance

Insurance contract or identification number	000400115521
Number of Individuals Covered	44
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $2,830
Total amount of fees paid to insurance company	USD $944
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $18,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,294
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	944
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050029

Policy instance

Insurance contract or identification number	000010050029
Number of Individuals Covered	12
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,454
Total amount of fees paid to insurance company	USD $485
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $730
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	485
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050030

Policy instance

Insurance contract or identification number	000010050030
Number of Individuals Covered	12
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $302
Total amount of fees paid to insurance company	USD $101
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $2,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $152
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	101
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010164745

Policy instance

Insurance contract or identification number	000010164745
Number of Individuals Covered	12
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $738
Total amount of fees paid to insurance company	USD $369
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $299
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	369
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010164746

Policy instance

Insurance contract or identification number	000010164746
Number of Individuals Covered	12
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,956
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $13,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $555
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024789

Policy instance

Insurance contract or identification number	00001D024789
Number of Individuals Covered	12
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $193
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D024790

Policy instance

Insurance contract or identification number	00001D024790
Number of Individuals Covered	12
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $2,431
Total amount of fees paid to insurance company	USD $1,215
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,122
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	1215
Insurance broker name	TRUST MANAGEMENT GROUP

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050030

Policy instance

Insurance contract or identification number	000010050030
Number of Individuals Covered	11
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $241
Total amount of fees paid to insurance company	USD $107
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $1,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010025972

Policy instance

Insurance contract or identification number	000010025972
Number of Individuals Covered	211
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $1,307
Total amount of fees paid to insurance company	USD $593
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $8,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )

Policy contract number

474757-HNO

Policy instance

Insurance contract or identification number	474757-HNO
Number of Individuals Covered	132
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $6,150
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $555,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5458197

Policy instance

Insurance contract or identification number	5458197
Number of Individuals Covered	102
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $3,981
Total amount of fees paid to insurance company	USD $195
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400115521

Policy instance

Insurance contract or identification number	000400115521
Number of Individuals Covered	88
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $1,533
Total amount of fees paid to insurance company	USD $788
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050029

Policy instance

Insurance contract or identification number	000010050029
Number of Individuals Covered	11
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $1,162
Total amount of fees paid to insurance company	USD $542
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010025972

Policy instance

Insurance contract or identification number	000010025972
Number of Individuals Covered	194
Insurance policy start date	2011-05-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $502
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $3,346

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	81
Insurance policy start date	2011-05-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $8,008
Health Insurance Welfare Benefit	Yes

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5458197

Policy instance

Insurance contract or identification number	5458197
Number of Individuals Covered	110
Insurance policy start date	2011-05-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $1,324
Total amount of fees paid to insurance company	USD $195
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,885

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400115521

Policy instance

Insurance contract or identification number	000400115521
Number of Individuals Covered	44
Insurance policy start date	2011-05-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $618
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,122

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050029

Policy instance

Insurance contract or identification number	000010050029
Number of Individuals Covered	12
Insurance policy start date	2011-05-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $462
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,081

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050030

Policy instance

Insurance contract or identification number	000010050030
Number of Individuals Covered	12
Insurance policy start date	2011-05-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $96
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $640

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050029

Policy instance

Insurance contract or identification number	000010050029
Number of Individuals Covered	12
Total amount of commissions paid to insurance broker	USD $1,772
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,459

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

004D04780

Policy instance

Insurance contract or identification number	004D04780
Number of Individuals Covered	41
Total amount of commissions paid to insurance broker	USD $460
Other welfare benefits provided	NG PLUS W/O SBA-3
Welfare Benefit Premiums Paid to Carrier	USD $4,604

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D018113

Policy instance

Insurance contract or identification number	00001D018113
Number of Individuals Covered	91
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $4,689
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,346

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

33605

Policy instance

Insurance contract or identification number	33605
Number of Individuals Covered	82
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $1,875
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $668,513

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010025972

Policy instance

Insurance contract or identification number	000010025972
Number of Individuals Covered	226
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $1,875
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $10,264

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010050030

Policy instance

Insurance contract or identification number	000010050030
Number of Individuals Covered	12
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $345
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $1,920

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Company Name:	FLORIDA EYE CLINIC, P.A.
Employer identification number (EIN):	591493386
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)