401k Plan data: MITCHELL, TITUS & CO. HEALTH BENEFIT PL plan

MITCHELL, TITUS & CO. HEALTH BENEFIT PL 401k Plan overview

Plan Name	MITCHELL, TITUS & CO. HEALTH BENEFIT PL
Plan identification number	501

MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MITCHELL & TITUS, LLP has sponsored the creation of one or more 401k plans.

Company Name: MITCHELL & TITUS, LLP

Employer identification number (EIN): 132781641

NAIC Classification: 541211
NAIC Description: Offices of Certified Public Accountants

Additional information about MITCHELL & TITUS, LLP

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1995-01-09

Company Identification Number: 1882822

Legal Registered Office Address: 80 PINE STREET
32ND FLOOR
NEW YORK
United States of America (USA)
10005

More information about MITCHELL & TITUS, LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MITCHELL, TITUS & CO. HEALTH BENEFIT PL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2018-01-01
501 2017-01-01 FREDERICK E DAVIS
501 2016-01-01 FREDERICK E. DAVIS JR.
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 FREDERICK E. DAVIS JR.
501 2011-01-01 FREDERICK E. DAVIS JR.
501 2009-01-01 JOHN BAIARDI

Plan Statistics for MITCHELL, TITUS & CO. HEALTH BENEFIT PL

401k plan membership statisitcs for MITCHELL, TITUS & CO. HEALTH BENEFIT PL

Measure Date Value
2019: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2019 401k membership
Total participants, beginning-of-year 2019-01-01 70
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 65
Total of all active and inactive participants 2019-01-01 65
Total participants 2019-01-01 65
2018: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2018 401k membership
Total participants, beginning-of-year 2018-01-01 70
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 70
Total of all active and inactive participants 2018-01-01 70
Total participants 2018-01-01 70
2017: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2017 401k membership
Total participants, beginning-of-year 2017-01-01 77
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 70
Total of all active and inactive participants 2017-01-01 70
Total participants 2017-01-01 70
2016: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2016 401k membership
Total participants, beginning-of-year 2016-01-01 81
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 76
Number of retired or separated participants receiving benefits 2016-01-01 1
Total of all active and inactive participants 2016-01-01 77
Total participants 2016-01-01 77
2015: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2015 401k membership
Total participants, beginning-of-year 2015-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 80
Number of retired or separated participants receiving benefits 2015-01-01 1
Total of all active and inactive participants 2015-01-01 81
Total participants 2015-01-01 81
2014: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2014 401k membership
Total participants, beginning-of-year 2014-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 117
Number of retired or separated participants receiving benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 118
Total participants 2014-01-01 118
2013: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2013 401k membership
Total participants, beginning-of-year 2013-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 138
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 3
Total of all active and inactive participants 2013-01-01 142
Total participants 2013-01-01 142
2012: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2012 401k membership
Total participants, beginning-of-year 2012-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 149
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 151
2011: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2011 401k membership
Total participants, beginning-of-year 2011-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 137
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 139
2009: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2009 401k membership
Total participants, beginning-of-year 2009-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 156
Total of all active and inactive participants 2009-01-01 156
Total participants 2009-01-01 156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 32

Measure	Date	Value
2019: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2019 401k membership
Total participants, beginning-of-year	2019-01-01	70
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	65
Total of all active and inactive participants	2019-01-01	65
Total participants	2019-01-01	65
2018: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2018 401k membership
Total participants, beginning-of-year	2018-01-01	70
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	70
Total of all active and inactive participants	2018-01-01	70
Total participants	2018-01-01	70
2017: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2017 401k membership
Total participants, beginning-of-year	2017-01-01	77
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	70
Total of all active and inactive participants	2017-01-01	70
Total participants	2017-01-01	70
2016: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2016 401k membership
Total participants, beginning-of-year	2016-01-01	81
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	76
Number of retired or separated participants receiving benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	77
Total participants	2016-01-01	77
2015: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2015 401k membership
Total participants, beginning-of-year	2015-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	80
Number of retired or separated participants receiving benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	81
Total participants	2015-01-01	81
2014: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2014 401k membership
Total participants, beginning-of-year	2014-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	117
Number of retired or separated participants receiving benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	118
Total participants	2014-01-01	118
2013: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2013 401k membership
Total participants, beginning-of-year	2013-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	138
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	3
Total of all active and inactive participants	2013-01-01	142
Total participants	2013-01-01	142
2012: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2012 401k membership
Total participants, beginning-of-year	2012-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	149
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	151
2011: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2011 401k membership
Total participants, beginning-of-year	2011-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	137
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	139
2009: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 2009 401k membership
Total participants, beginning-of-year	2009-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	156
Total of all active and inactive participants	2009-01-01	156
Total participants	2009-01-01	156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	32

Form 5500 Responses for MITCHELL, TITUS & CO. HEALTH BENEFIT PL

2019: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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: MITCHELL, TITUS & CO. HEALTH BENEFIT PL 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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	100
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $938
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 $938
Insurance broker organization code?	3

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

Policy contract number

0716201

Policy instance

Insurance contract or identification number	0716201
Number of Individuals Covered	104
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,973
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,973
Insurance broker organization code?	3

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	67
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $5,989
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $46,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,989
Insurance broker organization code?	3

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	95
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	89
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $7,187
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $54,266
Commission paid to Insurance Broker	USD $7,187
Insurance broker organization code?	3

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

Policy contract number

02Y3951

Policy instance

Insurance contract or identification number	02Y3951
Number of Individuals Covered	112
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $29,412
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,068,183
Commission paid to Insurance Broker	USD $29,412
Insurance broker organization code?	3

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	93
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $5,559
Total amount of fees paid to insurance company	USD $92
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $57,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,223
Insurance broker organization code?	3
Amount paid for insurance broker fees	92
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	NFP CORPORATE SERVICES NY, LLC

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	106
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $39,288
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $974,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,981
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES (NY) LLC

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
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 $1,573
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,309
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES (NY) LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	100
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3
Insurance broker name	THE VIKINGS AGENCY INC.

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	106
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,908
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $72,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,908
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	108
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3
Insurance broker name	THE VIKINGS AGENCY INC.

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	146
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $47,785
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,167,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,785
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
Number of Individuals Covered	160
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,521
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,521
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	191
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $53,740
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,334,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,740
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	180
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3
Insurance broker name	THE VIKINGS AGENCY INC.

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
Number of Individuals Covered	198
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,494
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,494
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	144
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $8,186
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $95,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,186
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	161
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3
Insurance broker name	THE VIKINGS AGENCY INC.

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
Number of Individuals Covered	241
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,367
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,367
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	229
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $54,355
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,357,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,355
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	162
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $8,695
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $101,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,695
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
Number of Individuals Covered	252
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,154
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,154
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	173
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $6,793
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $75,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,793
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	236
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $52,649
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,331,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,649
Insurance broker organization code?	3
Insurance broker name	THE DEBART GROUP INC.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	175
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3
Insurance broker name	THE VIKINGS AGENCY INC.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

ETB020364

Policy instance

Insurance contract or identification number	ETB020364
Number of Individuals Covered	168
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
Number of Individuals Covered	237
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,307
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	166
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $8,470
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $88,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	217
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $48,680
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,223,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

716201

Policy instance

Insurance contract or identification number	716201
Number of Individuals Covered	234
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,899
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $85,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

223131

Policy instance

Insurance contract or identification number	223131
Number of Individuals Covered	168
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $7,311
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD, STD
Welfare Benefit Premiums Paid to Carrier	USD $76,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

MT1517

Policy instance

Insurance contract or identification number	MT1517
Number of Individuals Covered	226
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $41,199
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,039,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MITCHELL & TITUS, LLP
Employer identification number (EIN):	132781641
NAIC Classification:	541211
NAIC Description:	Offices of Certified Public Accountants

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1995-01-09
Company Identification Number:	1882822
Legal Registered Office Address:	80 PINE STREET 32ND FLOOR NEW YORK United States of America (USA) 10005