401k Plan data: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC plan

UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 401k Plan overview

Plan Name	UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC
Plan identification number	502

UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 Other welfare benefit cover

401k Sponsoring company profile

UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC. has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

Employer identification number (EIN): 591867557

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

Additional information about UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1978-10-17

Company Identification Number: 744617

Legal Registered Office Address: 653 WEST 8TH ST.

JACKSONVILLE

32209

More information about UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 DR. PRADEEP KADAMBI 2023-07-28
502 2021-01-01 DR. PRADEEP KADAMBI 2022-07-29
502 2020-01-01 RICHARD SCANU 2021-06-08
502 2019-01-01 RICHARD SCANU 2020-07-08
502 2018-01-01
502 2017-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-01-01	DR. PRADEEP KADAMBI	2023-07-28
502	2021-01-01	DR. PRADEEP KADAMBI	2022-07-29
502	2020-01-01	RICHARD SCANU	2021-06-08
502	2019-01-01	RICHARD SCANU	2020-07-08
502	2018-01-01
502	2017-01-01

Plan Statistics for UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC

401k plan membership statisitcs for UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC

Measure Date Value
2022: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,572
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,569
Number of retired or separated participants receiving benefits 2022-01-01 4
Total of all active and inactive participants 2022-01-01 1,573
2021: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,379
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,567
Number of retired or separated participants receiving benefits 2021-01-01 5
Total of all active and inactive participants 2021-01-01 1,572
2020: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,494
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,373
Number of retired or separated participants receiving benefits 2020-01-01 6
Total of all active and inactive participants 2020-01-01 1,379
2019: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,357
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,328
Number of retired or separated participants receiving benefits 2019-01-01 2
Total of all active and inactive participants 2019-01-01 1,330
2018: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,408
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,375
Number of retired or separated participants receiving benefits 2018-01-01 5
Total of all active and inactive participants 2018-01-01 1,380
2017: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,457
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,114
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 1,114

Measure	Date	Value
2022: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,572
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,569
Number of retired or separated participants receiving benefits	2022-01-01	4
Total of all active and inactive participants	2022-01-01	1,573
2021: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,379
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,567
Number of retired or separated participants receiving benefits	2021-01-01	5
Total of all active and inactive participants	2021-01-01	1,572
2020: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,494
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,373
Number of retired or separated participants receiving benefits	2020-01-01	6
Total of all active and inactive participants	2020-01-01	1,379
2019: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,357
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,328
Number of retired or separated participants receiving benefits	2019-01-01	2
Total of all active and inactive participants	2019-01-01	1,330
2018: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,408
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,375
Number of retired or separated participants receiving benefits	2018-01-01	5
Total of all active and inactive participants	2018-01-01	1,380
2017: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,457
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,114
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	1,114

Form 5500 Responses for UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC

2022: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC 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 funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1139
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $30,033
Total amount of fees paid to insurance company	USD $0
Temporary Disability 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 $30,033
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1238
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,332
Total amount of fees paid to insurance company	USD $0
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
Commission paid to Insurance Broker	USD $14,332
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1464
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,150
Total amount of fees paid to insurance company	USD $0
Life 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 $13,150
Insurance broker organization code?	3

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

Policy contract number

0221709

Policy instance

Insurance contract or identification number	0221709
Number of Individuals Covered	2800
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $35,390
Total amount of fees paid to insurance company	USD $12,386
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $862,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,390
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2376
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,039
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,039
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2377
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $14,591
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,591
Insurance broker organization code?	3

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

Policy contract number

0221709

Policy instance

Insurance contract or identification number	0221709
Number of Individuals Covered	2741
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $41,232
Total amount of fees paid to insurance company	USD $11,273
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $824,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,232
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1481
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,951
Total amount of fees paid to insurance company	USD $0
Life 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 $11,951
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1278
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,499
Total amount of fees paid to insurance company	USD $0
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
Commission paid to Insurance Broker	USD $12,499
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1179
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $28,125
Total amount of fees paid to insurance company	USD $0
Temporary Disability 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 $28,125
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1121
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $36,762
Total amount of fees paid to insurance company	USD $0
Temporary Disability 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 $36,762
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1463
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,580
Total amount of fees paid to insurance company	USD $0
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
Commission paid to Insurance Broker	USD $18,580
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1522
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $16,404
Total amount of fees paid to insurance company	USD $0
Life 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 $16,404
Insurance broker organization code?	3

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

Policy contract number

0221709

Policy instance

Insurance contract or identification number	0221709
Number of Individuals Covered	2759
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $31,112
Total amount of fees paid to insurance company	USD $3,127
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $754,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,112
Amount paid for insurance broker fees	16
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2356
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14,094
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,094
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2251
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,873
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $128,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,873
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AN86

Policy instance

Insurance contract or identification number	GVTL0AN86
Number of Individuals Covered	602
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,122
Total amount of fees paid to insurance company	USD $13,755
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $128,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,048
Amount paid for insurance broker fees	10181
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AN86

Policy instance

Insurance contract or identification number	GLTD0AN86
Number of Individuals Covered	1181
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,239
Total amount of fees paid to insurance company	USD $24,928
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $255,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,023
Amount paid for insurance broker fees	20266
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AN86

Policy instance

Insurance contract or identification number	GLUG0AN86
Number of Individuals Covered	1433
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,661
Total amount of fees paid to insurance company	USD $9,044
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $91,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,479
Amount paid for insurance broker fees	7408
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0AN86

Policy instance

Insurance contract or identification number	GUC 0AN86
Number of Individuals Covered	1019
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $23,575
Total amount of fees paid to insurance company	USD $49,997
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $589,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,564
Amount paid for insurance broker fees	39489
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1155
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $44,313
Total amount of fees paid to insurance company	USD $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 $44,313
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1158
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $35,618
Total amount of fees paid to insurance company	USD $4,707
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 $35,618
Amount paid for insurance broker fees	4707
Additional information about fees paid to insurance broker	CONTIGENT COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0AN86

Policy instance

Insurance contract or identification number	GUC 0AN86
Number of Individuals Covered	1008
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $22,584
Total amount of fees paid to insurance company	USD $5,532
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $420,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,797
Amount paid for insurance broker fees	5532
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AN86

Policy instance

Insurance contract or identification number	GLUG0AN86
Number of Individuals Covered	1374
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,628
Total amount of fees paid to insurance company	USD $880
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $55,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,693
Amount paid for insurance broker fees	880
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AN86

Policy instance

Insurance contract or identification number	GLTD0AN86
Number of Individuals Covered	1177
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,938
Total amount of fees paid to insurance company	USD $2,475
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,476
Amount paid for insurance broker fees	2475
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AN86

Policy instance

Insurance contract or identification number	GVTL0AN86
Number of Individuals Covered	570
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,892
Total amount of fees paid to insurance company	USD $1,173
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $45,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,620
Amount paid for insurance broker fees	1173
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2092
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,948
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,948
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2046
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $12,524
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,524
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AN86

Policy instance

Insurance contract or identification number	GVTL0AN86
Number of Individuals Covered	591
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,927
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $123,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,927
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AN86

Policy instance

Insurance contract or identification number	GLTD0AN86
Number of Individuals Covered	1212
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,952
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $223,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,952
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AN86

Policy instance

Insurance contract or identification number	GLUG0AN86
Number of Individuals Covered	1396
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,523
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $88,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,523
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0AN86

Policy instance

Insurance contract or identification number	GUC 0AN86
Number of Individuals Covered	973
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $19,700
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $492,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,700
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

753281

Policy instance

Insurance contract or identification number	753281
Number of Individuals Covered	1136
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $38,220
Total amount of fees paid to insurance company	USD $9,664
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 $38,220
Amount paid for insurance broker fees	9664
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

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Company Name:	UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.
Employer identification number (EIN):	591867557
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1978-10-17
Company Identification Number:	744617
Legal Registered Office Address:	653 WEST 8TH ST. JACKSONVILLE 32209