401k Plan data: ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN plan

ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN
Plan identification number	501

ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT 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) Other welfare benefit cover

401k Sponsoring company profile

ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. has sponsored the creation of one or more 401k plans.

Company Name: ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A.

Employer identification number (EIN): 650452574

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

Additional information about ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1993-11-12

Company Identification Number: P93000079631

Legal Registered Office Address: 3059 GRAND AVENUE

MIAMI

33133

More information about ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01

Plan Statistics for ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN

401k plan membership statisitcs for ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN

Measure Date Value
2022: ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 107
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 120
Number of retired or separated participants receiving benefits 2022-06-01 0
Number of other retired or separated participants entitled to future benefits 2022-06-01 0
Total of all active and inactive participants 2022-06-01 120

Measure	Date	Value
2022: ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	107
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	120
Number of retired or separated participants receiving benefits	2022-06-01	0
Number of other retired or separated participants entitled to future benefits	2022-06-01	0
Total of all active and inactive participants	2022-06-01	120

Form 5500 Responses for ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN

2022: ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	First time form 5500 has been submitted	Yes
2022-06-01	Submission has been amended	No
2022-06-01	This submission is the final filing	No
2022-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-06-01	Plan is a collectively bargained plan	No
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

B1162

Policy instance

Insurance contract or identification number	B1162
Number of Individuals Covered	36
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $36,399
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,399
Insurance broker organization code?	3

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

Policy contract number

B1162

Policy instance

Insurance contract or identification number	B1162
Number of Individuals Covered	46
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $20,551
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,551
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1076115

Policy instance

Insurance contract or identification number	1076115
Number of Individuals Covered	183
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $14,971
Total amount of fees paid to insurance company	USD $5,389
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $155,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,971
Insurance broker organization code?	3
Amount paid for insurance broker fees	5389
Additional information about fees paid to insurance broker	BONUS

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Company Name:	ORTHOPAEDIC CENTER OF SOUTH FLORIDA, P.A.
Employer identification number (EIN):	650452574
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1993-11-12
Company Identification Number:	P93000079631
Legal Registered Office Address:	3059 GRAND AVENUE MIAMI 33133