401k Plan data: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN plan

CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN
Plan identification number	503

CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CENTRAL FLORIDA PULMONARY GROUP PA has sponsored the creation of one or more 401k plans.

Company Name: CENTRAL FLORIDA PULMONARY GROUP PA

Employer identification number (EIN): 591760017

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-01-01 YITZHAK D HAIM 2024-08-01 YITZHAK D HAIM 2024-08-01
503 2022-01-01 YITZHAK D HAIM 2024-02-15 YITZHAK D HAIM 2024-02-15
503 2021-01-01 YITZHAK D HAIM 2022-08-15
503 2020-01-01 YITZHAK D HAIM 2021-09-14 YITZHAK D HAIM 2021-09-14
503 2019-01-01 YITZHAK D HAIM 2020-10-01 YITZHAK D HAIM 2020-10-01
503 2018-01-01 YITZHAK D HAIM 2019-08-15 YITZHAK D HAIM 2019-08-15
503 2017-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2023-01-01	YITZHAK D HAIM	2024-08-01	YITZHAK D HAIM	2024-08-01
503	2022-01-01	YITZHAK D HAIM	2024-02-15	YITZHAK D HAIM	2024-02-15
503	2021-01-01	YITZHAK D HAIM	2022-08-15
503	2020-01-01	YITZHAK D HAIM	2021-09-14	YITZHAK D HAIM	2021-09-14
503	2019-01-01	YITZHAK D HAIM	2020-10-01	YITZHAK D HAIM	2020-10-01
503	2018-01-01	YITZHAK D HAIM	2019-08-15	YITZHAK D HAIM	2019-08-15
503	2017-01-01

Form 5500 Responses for CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN

2023: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS 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: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS 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: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS 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: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS 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: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS 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: CENTRAL FLORIDA PULMONARY GROUP PA WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

82-2723296

Policy instance

Insurance contract or identification number	82-2723296
Number of Individuals Covered	24
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $3,558
Total amount of fees paid to insurance company	USD $149
Other welfare benefits provided	OTHER - SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $25,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

930210

Policy instance

Insurance contract or identification number	930210
Number of Individuals Covered	163
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $8,873
Total amount of fees paid to insurance company	USD $92,986
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,686,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

423078

Policy instance

Insurance contract or identification number	423078
Number of Individuals Covered	43
Insurance policy start date	2022-12-01
Insurance policy end date	2023-12-01
Total amount of commissions paid to insurance broker	USD $3,099
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

Insurance contract or identification number	403423
Number of Individuals Covered	120
Insurance policy start date	2022-12-01
Insurance policy end date	2023-12-01
Total amount of commissions paid to insurance broker	USD $27,173
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $226,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

64980

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

64980

Policy instance

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

E6232-3G69N1

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

423078

Policy instance

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

Policy contract number

64980

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

64980

Policy instance

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

E6232-3G69N1

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

423078

Policy instance

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

E6232-3G69N1

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

64980

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

64980

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

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

Policy contract number

TS05318767

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

64980

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

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

Policy contract number

TS05318767

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

64980

Policy instance

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

Policy contract number

TS05318767

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

423078

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

403423

Policy instance

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

Policy contract number

64980

Policy instance

Potentially related plans

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Company Name:	CENTRAL FLORIDA PULMONARY GROUP PA
Employer identification number (EIN):	591760017
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)