401k Plan data: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN plan

THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 401k Plan overview

Plan Name	THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN
Plan identification number	501

THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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

THE CENTER FOR FAMILY SUPPORT, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE CENTER FOR FAMILY SUPPORT, INC.

Employer identification number (EIN): 131913807

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about THE CENTER FOR FAMILY SUPPORT, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1953-04-03

Company Identification Number: 87315

Legal Registered Office Address: ATTN: EXECUTIVE DIRECTOR
333 SEVENTH AVENUE, 9TH FLOOR
NEW YORK
United States of America (USA)
10001

More information about THE CENTER FOR FAMILY SUPPORT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 KEN D. SEMPLE 2023-07-31
501 2021-01-01 KEN D. SEMPLE 2022-08-16
501 2020-01-01 KEN D. SEMPLE 2021-08-31
501 2019-01-01 KEN D. SEMPLE 2020-10-15
501 2018-01-01 KEN SEMPLE
501 2017-01-01 MICHAEL MAZZOCCO
501 2016-01-01 MICHAEL MAZZOCCO
501 2015-01-01 MICHAEL MAZZOCCO
501 2014-01-01 MICHAEL MAZZOCCO
501 2013-01-01 MICHAEL MAZZOCCO
501 2012-01-01 MICHAEL MAZZOCCO
501 2011-01-01 MICHAEL MAZZOCCO
501 2009-01-01 MICHAEL MAZZOCCO
501 2008-01-01 MICHAEL MAZZOCCO
501 2007-01-01 MICHAEL MAZZOCCO
501 2006-01-01 MICHAEL MAZZOCCO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	KEN D. SEMPLE	2023-07-31
501	2021-01-01	KEN D. SEMPLE	2022-08-16
501	2020-01-01	KEN D. SEMPLE	2021-08-31
501	2019-01-01	KEN D. SEMPLE	2020-10-15
501	2018-01-01	KEN SEMPLE
501	2017-01-01	MICHAEL MAZZOCCO
501	2016-01-01	MICHAEL MAZZOCCO
501	2015-01-01	MICHAEL MAZZOCCO
501	2014-01-01	MICHAEL MAZZOCCO
501	2013-01-01	MICHAEL MAZZOCCO
501	2012-01-01	MICHAEL MAZZOCCO
501	2011-01-01	MICHAEL MAZZOCCO
501	2009-01-01	MICHAEL MAZZOCCO
501	2008-01-01	MICHAEL MAZZOCCO
501	2007-01-01	MICHAEL MAZZOCCO
501	2006-01-01	MICHAEL MAZZOCCO

Plan Statistics for THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN

401k plan membership statisitcs for THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN

Measure Date Value
2022: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 269
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 260
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 260
Number of employers contributing to the scheme 2022-01-01 0
2021: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 269
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 269
Number of employers contributing to the scheme 2021-01-01 0
2020: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 285
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 279
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 0
Total of all active and inactive participants 2020-01-01 279
Number of employers contributing to the scheme 2020-01-01 0
2019: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 329
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 285
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 285
Number of employers contributing to the scheme 2019-01-01 0
2018: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 339
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 329
Total of all active and inactive participants 2018-01-01 329
2017: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 339
Total of all active and inactive participants 2017-01-01 339
Total participants 2017-01-01 339
2016: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 213
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 208
Total of all active and inactive participants 2016-01-01 208
Total participants 2016-01-01 208
2015: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 340
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 213
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 2015-01-01 213
Total participants 2015-01-01 213
2014: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 324
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 340
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 2014-01-01 340
Total participants 2014-01-01 340
2013: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 333
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 324
Total of all active and inactive participants 2013-01-01 324
Total participants 2013-01-01 324
2012: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 305
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 333
Total of all active and inactive participants 2012-01-01 333
Total participants 2012-01-01 333
2011: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 267
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 305
Total of all active and inactive participants 2011-01-01 305
Total participants 2011-01-01 305
2009: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 279
Total of all active and inactive participants 2009-01-01 279
Total participants 2009-01-01 279
2008: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 269
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 269
Total of all active and inactive participants 2008-01-01 269
Total participants 2008-01-01 269
2007: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 224
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 224
Total of all active and inactive participants 2007-01-01 224
Total participants 2007-01-01 224
2006: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2006 401k membership
Total participants, beginning-of-year 2006-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 231
Total of all active and inactive participants 2006-01-01 231
Total participants 2006-01-01 231

Measure	Date	Value
2022: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	260
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	260
Number of employers contributing to the scheme	2022-01-01	0
2021: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	269
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	269
Number of employers contributing to the scheme	2021-01-01	0
2020: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	285
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	279
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	0
Total of all active and inactive participants	2020-01-01	279
Number of employers contributing to the scheme	2020-01-01	0
2019: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	329
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	285
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	285
Number of employers contributing to the scheme	2019-01-01	0
2018: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	339
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	329
Total of all active and inactive participants	2018-01-01	329
2017: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	339
Total of all active and inactive participants	2017-01-01	339
Total participants	2017-01-01	339
2016: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	213
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	208
Total of all active and inactive participants	2016-01-01	208
Total participants	2016-01-01	208
2015: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	340
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	213
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	213
Total participants	2015-01-01	213
2014: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	324
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	340
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	340
Total participants	2014-01-01	340
2013: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	333
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	324
Total of all active and inactive participants	2013-01-01	324
Total participants	2013-01-01	324
2012: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	305
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	333
Total of all active and inactive participants	2012-01-01	333
Total participants	2012-01-01	333
2011: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	267
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	305
Total of all active and inactive participants	2011-01-01	305
Total participants	2011-01-01	305
2009: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	279
Total of all active and inactive participants	2009-01-01	279
Total participants	2009-01-01	279
2008: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	269
Total of all active and inactive participants	2008-01-01	269
Total participants	2008-01-01	269
2007: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	224
Total of all active and inactive participants	2007-01-01	224
Total participants	2007-01-01	224
2006: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	231
Total of all active and inactive participants	2006-01-01	231
Total participants	2006-01-01	231

Form 5500 Responses for THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN

2022: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH 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: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2008: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2007: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2006: THE CENTER FOR FAMILY SUPPORT, INC. HEALTH PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	First time form 5500 has been submitted	Yes
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

530685

Policy instance

Insurance contract or identification number	530685
Number of Individuals Covered	50
Insurance policy start date	2022-01-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $4,372
Total amount of fees paid to insurance company	USD $429
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $41,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,372
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	260
Insurance policy start date	2022-01-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $1,046
Total amount of fees paid to insurance company	USD $87
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,046
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

300580

Policy instance

Insurance contract or identification number	300580
Number of Individuals Covered	366
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $192,948
Total amount of fees paid to insurance company	USD $20,646
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,602,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $192,948
Amount paid for insurance broker fees	20646
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

625432

Policy instance

Insurance contract or identification number	625432
Number of Individuals Covered	314
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $1,108
Total amount of fees paid to insurance company	USD $175,955
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,562,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,108
Amount paid for insurance broker fees	175955
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEE, INCENTIVE COMPENSATION
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

625432

Policy instance

Insurance contract or identification number	625432
Number of Individuals Covered	269
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $13,549
Total amount of fees paid to insurance company	USD $1,253
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,549
Amount paid for insurance broker fees	1253
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

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

Policy contract number

530685

Policy instance

Insurance contract or identification number	530685
Number of Individuals Covered	88
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,146
Total amount of fees paid to insurance company	USD $276
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $32,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,146
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

530685

Policy instance

Insurance contract or identification number	530685
Number of Individuals Covered	210
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,481
Total amount of fees paid to insurance company	USD $123
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $88,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,481
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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

Policy contract number

484808

Policy instance

Insurance contract or identification number	484808
Number of Individuals Covered	279
Insurance policy start date	2020-01-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $1,351
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $13,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,350
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

530685

Policy instance

Insurance contract or identification number	530685
Number of Individuals Covered	90
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,498
Total amount of fees paid to insurance company	USD $233
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $30,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,316
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	17
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,153
Total amount of fees paid to insurance company	USD $96
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,153
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

625432

Policy instance

Insurance contract or identification number	625432
Number of Individuals Covered	325
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $140,195
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,944,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	140195
Additional information about fees paid to insurance broker	BENFIT ADVISOR FEES
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

625432

Policy instance

Insurance contract or identification number	625432
Number of Individuals Covered	329
Insurance policy start date	2019-02-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $127,860
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,685,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	127860
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEE
Insurance broker organization code?	3

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

1123252000

Policy instance

Insurance contract or identification number	1123252000
Number of Individuals Covered	283
Insurance policy start date	2019-01-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $7,392
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $184,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $7,392
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	17
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,183
Total amount of fees paid to insurance company	USD $138
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,183
Amount paid for insurance broker fees	138
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

484808

Policy instance

Insurance contract or identification number	484808
Number of Individuals Covered	285
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $20,012
Total amount of fees paid to insurance company	USD $9,841
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $199,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,996
Amount paid for insurance broker fees	9841
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

1123252 000

Policy instance

Insurance contract or identification number	1123252 000
Number of Individuals Covered	247
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Other welfare benefits provided	POS
Welfare Benefit Premiums Paid to Carrier	USD $2,283,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

484808

Policy instance

Insurance contract or identification number	484808
Number of Individuals Covered	329
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $20,459
Total amount of fees paid to insurance company	USD $9,917
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,459
Amount paid for insurance broker fees	9917
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	19
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $1,174
Total amount of fees paid to insurance company	USD $137
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,174
Amount paid for insurance broker fees	137
Insurance broker organization code?	3

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

Policy contract number

00539686

Policy instance

Insurance contract or identification number	00539686
Number of Individuals Covered	82
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $816
Total amount of fees paid to insurance company	USD $270
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $788
Amount paid for insurance broker fees	270
Insurance broker organization code?	3

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

Policy contract number

00539686

Policy instance

Insurance contract or identification number	00539686
Number of Individuals Covered	70
Insurance policy start date	2017-06-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $415
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $386
Insurance broker name	FERRARA FINANCIAL GROUP, LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	21
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $1,297
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,297
Insurance broker name	PREFERRED BENEFITS GROUP INC

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

Policy contract number

484808

Policy instance

Insurance contract or identification number	484808
Number of Individuals Covered	339
Insurance policy start date	2016-02-01
Insurance policy end date	2017-01-31
Total amount of commissions paid to insurance broker	USD $21,229
Total amount of fees paid to insurance company	USD $9,300
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $212,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,229
Amount paid for insurance broker fees	9300
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	301
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $88,827
Other welfare benefits provided	POS
Welfare Benefit Premiums Paid to Carrier	USD $2,220,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,827
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF01601

Policy instance

Insurance contract or identification number	CF01601
Number of Individuals Covered	5
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $1,598
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,598
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP INC

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	213
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $79,659
Other welfare benefits provided	POS
Welfare Benefit Premiums Paid to Carrier	USD $2,063,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $79,659
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95234 )

Policy contract number

0865855HNO

Policy instance

Insurance contract or identification number	0865855HNO
Number of Individuals Covered	21
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $4,974
Total amount of fees paid to insurance company	USD $1,658
Welfare Benefit Premiums Paid to Carrier	USD $184,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,974
Amount paid for insurance broker fees	1658
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

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

Policy contract number

484808

Policy instance

Insurance contract or identification number	484808
Number of Individuals Covered	164
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $20,286
Total amount of fees paid to insurance company	USD $9,036
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,286
Amount paid for insurance broker fees	9036
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	23
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $1,691
Total amount of fees paid to insurance company	USD $141
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $11,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,691
Amount paid for insurance broker fees	141
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	363
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $80,262
Other welfare benefits provided	POS
Welfare Benefit Premiums Paid to Carrier	USD $2,006,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,262
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

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

Policy contract number

484808

Policy instance

Insurance contract or identification number	484808
Number of Individuals Covered	170
Total amount of commissions paid to insurance broker	USD $10,508
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,508
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95234 )

Policy contract number

US021349

Policy instance

Insurance contract or identification number	US021349
Number of Individuals Covered	29
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $6,510
Total amount of fees paid to insurance company	USD $2,170
Welfare Benefit Premiums Paid to Carrier	USD $210,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,510
Amount paid for insurance broker fees	2170
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	19
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $863
Total amount of fees paid to insurance company	USD $72
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $5,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $863
Amount paid for insurance broker fees	72
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	324
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $72,352
Welfare Benefit Premiums Paid to Carrier	USD $1,809,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,352
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 95479 )

Policy contract number

CF01601

Policy instance

Insurance contract or identification number	CF01601
Number of Individuals Covered	5
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,956
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,956
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

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

Policy contract number

TM05982218

Policy instance

Insurance contract or identification number	TM05982218
Number of Individuals Covered	351
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $11,375
Total amount of fees paid to insurance company	USD $276
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,449
Amount paid for insurance broker fees	276
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	NFP INS SERVICES, INC.

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95234 )

Policy contract number

US021349

Policy instance

Insurance contract or identification number	US021349
Number of Individuals Covered	48
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $8,932
Total amount of fees paid to insurance company	USD $2,977
Welfare Benefit Premiums Paid to Carrier	USD $298,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,932
Amount paid for insurance broker fees	2977
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95234 )

Policy contract number

US021349

Policy instance

Insurance contract or identification number	US021349
Number of Individuals Covered	51
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $8,767
Total amount of fees paid to insurance company	USD $2,362
Welfare Benefit Premiums Paid to Carrier	USD $267,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,767
Amount paid for insurance broker fees	2362
Additional information about fees paid to insurance broker	PM KP BONUS
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

570052

Policy instance

Insurance contract or identification number	570052
Number of Individuals Covered	19
Insurance policy start date	2011-02-01
Insurance policy end date	2012-02-01
Total amount of commissions paid to insurance broker	USD $781
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $4,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $781
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT003

Policy instance

Insurance contract or identification number	10092NT003
Number of Individuals Covered	119
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $86
Other welfare benefits provided	POS CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $2,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP

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

Policy contract number

TM05982218

Policy instance

Insurance contract or identification number	TM05982218
Number of Individuals Covered	333
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $9,346
Total amount of fees paid to insurance company	USD $6
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,720
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	NFP INS SERVICES, INC.

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF01601

Policy instance

Insurance contract or identification number	CF01601
Number of Individuals Covered	6
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $2,511
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,511
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	330
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $61,286
Other welfare benefits provided	POS CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $1,532,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,286
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT003

Policy instance

Insurance contract or identification number	10092NT003
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $311,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

454-6391-00

Policy instance

Insurance contract or identification number	454-6391-00
Number of Individuals Covered	305
Insurance policy start date	2010-02-01
Insurance policy end date	2011-02-01
Total amount of commissions paid to insurance broker	USD $24,700
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	248
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $50,299
Welfare Benefit Premiums Paid to Carrier	USD $1,257,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

10092NT000

Policy instance

Insurance contract or identification number	10092NT000
Number of Individuals Covered	231
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $49,790
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,244,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,790
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95234 )

Policy contract number

US021349-SHORT

Policy instance

Insurance contract or identification number	US021349-SHORT
Number of Individuals Covered	59
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $634
Total amount of fees paid to insurance company	USD $211
Welfare Benefit Premiums Paid to Carrier	USD $19,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $634
Amount paid for insurance broker fees	211
Additional information about fees paid to insurance broker	PM KP BONUS
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF01601

Policy instance

Insurance contract or identification number	CF01601
Number of Individuals Covered	6
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,546
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,546
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP, INC.

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

Policy contract number

TM057240970002

Policy instance

Insurance contract or identification number	TM057240970002
Number of Individuals Covered	437
Insurance policy start date	2009-02-01
Insurance policy end date	2010-01-31
Total amount of commissions paid to insurance broker	USD $12,410
Total amount of fees paid to insurance company	USD $2,308
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,410
Amount paid for insurance broker fees	2308
Insurance broker organization code?	3
Insurance broker name	PREFERRED BENEFITS GROUP INC

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Company Name:	THE CENTER FOR FAMILY SUPPORT, INC.
Employer identification number (EIN):	131913807
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1953-04-03
Company Identification Number:	87315
Legal Registered Office Address:	ATTN: EXECUTIVE DIRECTOR 333 SEVENTH AVENUE, 9TH FLOOR NEW YORK United States of America (USA) 10001