401k Plan data: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN plan

EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 401k Plan overview

Plan Name	EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN
Plan identification number	501

EMERGENCY PHYSICIANS OF TIDEWATER PLC 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

401k Sponsoring company profile

EMERGENCY PHYSICIANS OF TIDEWATER PLC has sponsored the creation of one or more 401k plans.

Company Name: EMERGENCY PHYSICIANS OF TIDEWATER PLC

Employer identification number (EIN): 541141362

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

Additional information about EMERGENCY PHYSICIANS OF TIDEWATER PLC

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1992-12-10

Company Identification Number: S000927

Legal Registered Office Address: 992 FIRST COLONIAL ROAD

VIRGINIA BEACH
United States of America (USA)
23452

More information about EMERGENCY PHYSICIANS OF TIDEWATER PLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 ROBERT HUNDLEY
501 2016-01-01 ROBERT HUNDLEY
501 2015-01-01 ROBERT HUNDLEY
501 2014-01-01 ROBERT HUNDLEY

Plan Statistics for EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN

401k plan membership statisitcs for EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN

Measure Date Value
2022: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 194
Number of retired or separated participants receiving benefits 2022-01-01 6
Total of all active and inactive participants 2022-01-01 200
2021: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 135
Total of all active and inactive participants 2021-01-01 135
2020: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 125
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 5
Total of all active and inactive participants 2020-01-01 130
2019: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 138
Number of retired or separated participants receiving benefits 2019-01-01 4
Total of all active and inactive participants 2019-01-01 142
2018: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 126
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 126
2017: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 125
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 2017-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 125
2016: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 121
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 121
2015: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 145
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 145
2014: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 90
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 128
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 128
Total participants 2014-01-01 128

Measure	Date	Value
2022: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	194
Number of retired or separated participants receiving benefits	2022-01-01	6
Total of all active and inactive participants	2022-01-01	200
2021: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	135
Total of all active and inactive participants	2021-01-01	135
2020: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	125
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	5
Total of all active and inactive participants	2020-01-01	130
2019: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	138
Number of retired or separated participants receiving benefits	2019-01-01	4
Total of all active and inactive participants	2019-01-01	142
2018: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	126
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	126
2017: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	125
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	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	125
2016: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	121
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	121
2015: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	145
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	145
2014: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	90
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	128
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	128
Total participants	2014-01-01	128

Form 5500 Responses for EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN

2022: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA 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: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA 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: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA 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: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA 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: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA 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: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: EMERGENCY PHYSICIANS OF TIDEWATER PLC CAFETERIA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

STD94049

Policy instance

Insurance contract or identification number	STD94049
Number of Individuals Covered	188
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,667
Total amount of fees paid to insurance company	USD $180
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,667
Amount paid for insurance broker fees	180
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32300

Policy instance

Insurance contract or identification number	32300
Number of Individuals Covered	151
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,655
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $747,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,655
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	35
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,828
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $207,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,828
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68794

Policy instance

Insurance contract or identification number	68794
Number of Individuals Covered	79
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,454
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $411,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,454
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68795

Policy instance

Insurance contract or identification number	68795
Number of Individuals Covered	15
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,535
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,535
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00569558

Policy instance

Insurance contract or identification number	00569558
Number of Individuals Covered	193
Total amount of commissions paid to insurance broker	USD $11,635
Total amount of fees paid to insurance company	USD $1,807
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,ACCIDENT,CANCER,CRIT ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $70,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,635
Amount paid for insurance broker fees	1807
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	188
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $66,560
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $554,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,560
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32300

Policy instance

Insurance contract or identification number	32300
Number of Individuals Covered	150
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $14,807
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $653,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,807
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	42
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,706
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $258,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,706
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68794

Policy instance

Insurance contract or identification number	68794
Number of Individuals Covered	54
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,999
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $259,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,999
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68795

Policy instance

Insurance contract or identification number	68795
Number of Individuals Covered	9
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,131
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,131
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00569558

Policy instance

Insurance contract or identification number	00569558
Number of Individuals Covered	155
Total amount of commissions paid to insurance broker	USD $17,631
Total amount of fees paid to insurance company	USD $5,124
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, AD&D, CANCER,CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $151,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,631
Amount paid for insurance broker fees	5124
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	160
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $29,310
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $244,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,310
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

STT94049

Policy instance

Insurance contract or identification number	STT94049
Number of Individuals Covered	160
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,891
Total amount of fees paid to insurance company	USD $75
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,891
Insurance broker organization code?	3
Amount paid for insurance broker fees	75

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	164
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $41,850
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 $41,850
Insurance broker organization code?	3

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	162
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14,848
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 $14,848
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32300

Policy instance

Insurance contract or identification number	32300
Number of Individuals Covered	125
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,251
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $499,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,251
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	34
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,191
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $188,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,191
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68794

Policy instance

Insurance contract or identification number	68794
Number of Individuals Covered	75
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,302
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $358,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,302
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68795

Policy instance

Insurance contract or identification number	68795
Number of Individuals Covered	12
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,576
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,576
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00569558

Policy instance

Insurance contract or identification number	00569558
Number of Individuals Covered	164
Total amount of commissions paid to insurance broker	USD $21,900
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, AD&D, CANCER,CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $178,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,900
Insurance broker organization code?	3

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	163
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,015
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 $9,015
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-046987

Policy instance

Insurance contract or identification number	010-046987
Number of Individuals Covered	147
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $955
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $955
Insurance broker organization code?	3

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

A17072

Policy instance

Insurance contract or identification number	A17072
Number of Individuals Covered	198
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,136
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,432
Insurance broker organization code?	3

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	163
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,911
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 $1,911
Insurance broker organization code?	3

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	163
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $25,025
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 $25,025
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32300

Policy instance

Insurance contract or identification number	32300
Number of Individuals Covered	78
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $318,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	45
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $215,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68794

Policy instance

Insurance contract or identification number	68794
Number of Individuals Covered	81
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $386,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

68795

Policy instance

Insurance contract or identification number	68795
Number of Individuals Covered	24
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

35359

Policy instance

Insurance contract or identification number	35359
Number of Individuals Covered	113
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $17,811
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $559,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,811
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 )

Policy contract number

35359

Policy instance

Insurance contract or identification number	35359
Number of Individuals Covered	85
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,379
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $326,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,379
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

460278

Policy instance

Insurance contract or identification number	460278
Number of Individuals Covered	102
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,040
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,040
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	125
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,639
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 $1,639
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY INC

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	125
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $25,175
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 $25,175
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY INC

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

Policy contract number

160988

Policy instance

Insurance contract or identification number	160988
Number of Individuals Covered	124
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,889
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 $8,889
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY INC

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

35359

Policy instance

Insurance contract or identification number	35359
Number of Individuals Covered	46
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,715
Total amount of fees paid to insurance company	USD $98
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $481,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,715
Amount paid for insurance broker fees	98
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 )

Policy contract number

35359

Policy instance

Insurance contract or identification number	35359
Number of Individuals Covered	51
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,434
Total amount of fees paid to insurance company	USD $38
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $191,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,434
Amount paid for insurance broker fees	38
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

A00491-000, 099

Policy instance

Insurance contract or identification number	A00491-000, 099
Number of Individuals Covered	220
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,907
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,907
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY INC

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

Policy contract number

10171255

Policy instance

Insurance contract or identification number	10171255
Number of Individuals Covered	114
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,357
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,357
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY LLC

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

Policy contract number

10171356

Policy instance

Insurance contract or identification number	10171356
Number of Individuals Covered	115
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,686
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $47,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,686
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY LLC

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

Policy contract number

10171355

Policy instance

Insurance contract or identification number	10171355
Number of Individuals Covered	115
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,508
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,508
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY LLC

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

A00491-000, 099

Policy instance

Insurance contract or identification number	A00491-000, 099
Number of Individuals Covered	205
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,397
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,397
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY INC

HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 )

Policy contract number

35359

Policy instance

Insurance contract or identification number	35359
Number of Individuals Covered	35
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,643
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,643
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

35359

Policy instance

Insurance contract or identification number	35359
Number of Individuals Covered	134
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $20,832
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $601,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,832
Insurance broker organization code?	3
Insurance broker name	TFA BENEFITS

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Company Name:	EMERGENCY PHYSICIANS OF TIDEWATER PLC
Employer identification number (EIN):	541141362
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1992-12-10
Company Identification Number:	S000927
Legal Registered Office Address:	992 FIRST COLONIAL ROAD VIRGINIA BEACH United States of America (USA) 23452