401k Plan data: SJB GROUP, INC plan

SJB GROUP, INC 401k Plan overview

Plan Name	SJB GROUP, INC
Plan identification number	501

SJB GROUP, INC Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

SJB GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: SJB GROUP, INC.

Employer identification number (EIN): 201963915

NAIC Classification: 441110
NAIC Description: New Car Dealers

Additional information about SJB GROUP, INC.

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 635816

More information about SJB GROUP, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SJB GROUP, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 SUSAN J BRAUER 2023-09-14 SUSAN J BRAUER 2023-09-14
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 SUSAN J BRAUER
501 2016-01-01 SUSAN J BRAUER
501 2015-01-01 SUSAN J BRAUER
501 2014-01-01 SUSAN J BRAUER SUSAN J BRAUER 2015-09-29
501 2013-01-01 SUSAN J BRAUER SUSAN BRAUER 2014-09-22
501 2012-01-01 SUSAN J BRAUER SUSAN J BRAUER 2013-10-14
501 2011-01-01 SUSAN J BRAUER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	SUSAN J BRAUER	2023-09-14	SUSAN J BRAUER	2023-09-14
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	SUSAN J BRAUER
501	2016-01-01	SUSAN J BRAUER
501	2015-01-01	SUSAN J BRAUER
501	2014-01-01	SUSAN J BRAUER		SUSAN J BRAUER	2015-09-29
501	2013-01-01	SUSAN J BRAUER		SUSAN BRAUER	2014-09-22
501	2012-01-01	SUSAN J BRAUER		SUSAN J BRAUER	2013-10-14
501	2011-01-01	SUSAN J BRAUER

Plan Statistics for SJB GROUP, INC

401k plan membership statisitcs for SJB GROUP, INC

Measure Date Value
2022: SJB GROUP, INC 2022 401k membership
Total participants, beginning-of-year 2022-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 124
Total of all active and inactive participants 2022-01-01 124
Total participants 2022-01-01 124
2021: SJB GROUP, INC 2021 401k membership
Total participants, beginning-of-year 2021-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 129
Total of all active and inactive participants 2021-01-01 129
Total participants 2021-01-01 129
2020: SJB GROUP, INC 2020 401k membership
Total participants, beginning-of-year 2020-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 129
Total of all active and inactive participants 2020-01-01 129
Total participants 2020-01-01 129
2019: SJB GROUP, INC 2019 401k membership
Total participants, beginning-of-year 2019-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 220
Total of all active and inactive participants 2019-01-01 220
Total participants 2019-01-01 220
2018: SJB GROUP, INC 2018 401k membership
Total participants, beginning-of-year 2018-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 134
Total of all active and inactive participants 2018-01-01 134
Total participants 2018-01-01 134
2017: SJB GROUP, INC 2017 401k membership
Total participants, beginning-of-year 2017-01-01 71
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 133
Total of all active and inactive participants 2017-01-01 133
Total participants 2017-01-01 133
2016: SJB GROUP, INC 2016 401k membership
Total participants, beginning-of-year 2016-01-01 73
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 71
Total of all active and inactive participants 2016-01-01 71
Total participants 2016-01-01 71
2015: SJB GROUP, INC 2015 401k membership
Total participants, beginning-of-year 2015-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 73
Total of all active and inactive participants 2015-01-01 73
Total participants 2015-01-01 73
2014: SJB GROUP, INC 2014 401k membership
Total participants, beginning-of-year 2014-01-01 81
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 78
Total of all active and inactive participants 2014-01-01 78
2013: SJB GROUP, INC 2013 401k membership
Total participants, beginning-of-year 2013-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 81
Total of all active and inactive participants 2013-01-01 81
2012: SJB GROUP, INC 2012 401k membership
Total participants, beginning-of-year 2012-01-01 71
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 92
Total of all active and inactive participants 2012-01-01 92
2011: SJB GROUP, INC 2011 401k membership
Total participants, beginning-of-year 2011-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 71
Total of all active and inactive participants 2011-01-01 71

Measure	Date	Value
2022: SJB GROUP, INC 2022 401k membership
Total participants, beginning-of-year	2022-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	124
Total of all active and inactive participants	2022-01-01	124
Total participants	2022-01-01	124
2021: SJB GROUP, INC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	129
Total of all active and inactive participants	2021-01-01	129
Total participants	2021-01-01	129
2020: SJB GROUP, INC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	129
Total of all active and inactive participants	2020-01-01	129
Total participants	2020-01-01	129
2019: SJB GROUP, INC 2019 401k membership
Total participants, beginning-of-year	2019-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	220
Total of all active and inactive participants	2019-01-01	220
Total participants	2019-01-01	220
2018: SJB GROUP, INC 2018 401k membership
Total participants, beginning-of-year	2018-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	134
Total of all active and inactive participants	2018-01-01	134
Total participants	2018-01-01	134
2017: SJB GROUP, INC 2017 401k membership
Total participants, beginning-of-year	2017-01-01	71
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	133
Total of all active and inactive participants	2017-01-01	133
Total participants	2017-01-01	133
2016: SJB GROUP, INC 2016 401k membership
Total participants, beginning-of-year	2016-01-01	73
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	71
Total of all active and inactive participants	2016-01-01	71
Total participants	2016-01-01	71
2015: SJB GROUP, INC 2015 401k membership
Total participants, beginning-of-year	2015-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	73
Total of all active and inactive participants	2015-01-01	73
Total participants	2015-01-01	73
2014: SJB GROUP, INC 2014 401k membership
Total participants, beginning-of-year	2014-01-01	81
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	78
Total of all active and inactive participants	2014-01-01	78
2013: SJB GROUP, INC 2013 401k membership
Total participants, beginning-of-year	2013-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	81
Total of all active and inactive participants	2013-01-01	81
2012: SJB GROUP, INC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	71
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	92
Total of all active and inactive participants	2012-01-01	92
2011: SJB GROUP, INC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	71
Total of all active and inactive participants	2011-01-01	71

Form 5500 Responses for SJB GROUP, INC

2022: SJB GROUP, INC 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: SJB GROUP, INC 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: SJB GROUP, INC 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: SJB GROUP, INC 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: SJB GROUP, INC 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: SJB GROUP, INC 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: SJB GROUP, INC 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: SJB GROUP, INC 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: SJB GROUP, INC 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: SJB GROUP, INC 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: SJB GROUP, INC 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: SJB GROUP, INC 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

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0225584

Policy instance

Insurance contract or identification number	0225584
Number of Individuals Covered	124
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $25,293
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,076,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,865
Insurance broker organization code?	3

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

10366

Policy instance

Insurance contract or identification number	10366
Number of Individuals Covered	197
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $2,092
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,092
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0225584

Policy instance

Insurance contract or identification number	0225584
Number of Individuals Covered	129
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $21,338
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,093,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,555
Insurance broker organization code?	3

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

10366

Policy instance

Insurance contract or identification number	10366
Number of Individuals Covered	197
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $2,092
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,092
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0225584

Policy instance

Insurance contract or identification number	0225584
Number of Individuals Covered	129
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $21,338
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,093,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,555
Insurance broker organization code?	3

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

10366

Policy instance

Insurance contract or identification number	10366
Number of Individuals Covered	160
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $2,268
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,268
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0225584

Policy instance

Insurance contract or identification number	0225584
Number of Individuals Covered	220
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $22,340
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,037,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,485
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0225584

Policy instance

Insurance contract or identification number	0225584
Number of Individuals Covered	134
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $21,210
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $975,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,953
Insurance broker organization code?	3

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

10366

Policy instance

Insurance contract or identification number	10366
Number of Individuals Covered	133
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,085
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,085
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0225584

Policy instance

Insurance contract or identification number	0225584
Number of Individuals Covered	133
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $22,595
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $948,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,009
Insurance broker organization code?	3
Insurance broker name	MARSHALL AND STERLING INC

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

Policy contract number

905400

Policy instance

Insurance contract or identification number	905400
Number of Individuals Covered	73
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,281
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

SG14477

Policy instance

Insurance contract or identification number	SG14477
Number of Individuals Covered	71
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $5,629
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $913,987
Commission paid to Insurance Broker	USD $5,629
Insurance broker organization code?	3
Insurance broker name	FNA INSURANCE SERVIES INC - GA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	69
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $147,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50020404

Policy instance

Insurance contract or identification number	50020404
Number of Individuals Covered	78
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $1,111
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,111
Insurance broker organization code?	3
Insurance broker name	HORIZON INSURANCE COMPANY

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	69
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $761,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	74
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F008249

Policy instance

Insurance contract or identification number	F008249
Number of Individuals Covered	81
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $582
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $478
Insurance broker organization code?	3
Insurance broker name	A MARSH & MCLENNAN AGENCY CO

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	67
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $128,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	64
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $646,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	73
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	64
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $131,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	64
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $649,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F008249

Policy instance

Insurance contract or identification number	F008249
Number of Individuals Covered	92
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $639
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $368
Insurance broker organization code?	3
Insurance broker name	THE NIA GROUP LLC

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	82
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

2022

Policy instance

Insurance contract or identification number	2022
Number of Individuals Covered	77
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,195
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F008249

Policy instance

Insurance contract or identification number	F008249
Number of Individuals Covered	94
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,136
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	71
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $121,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	71
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $604,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	72
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,765
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $524,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

82725

Policy instance

Insurance contract or identification number	82725
Number of Individuals Covered	70
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,268
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $105,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F008249

Policy instance

Insurance contract or identification number	F008249
Number of Individuals Covered	106
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $646
Total amount of fees paid to insurance company	USD $793
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

2022

Policy instance

Insurance contract or identification number	2022
Number of Individuals Covered	79
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,378
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

SJB GROUP, LLC. 401(K) PROFIT SHARING PLAN [EIN = 720454164]

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Company Name:	SJB GROUP, INC.
Employer identification number (EIN):	201963915
NAIC Classification:	441110
NAIC Description:	New Car Dealers

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	635816