401k Plan data: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN plan

NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 401k Plan overview

Plan Name	NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN
Plan identification number	505

NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN Benefits

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

401k Sponsoring company profile

NEW JERSEY ORGAN AND TISSUE SHARING NETWORK, INC. has sponsored the creation of one or more 401k plans.

Company Name: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK, INC.

Employer identification number (EIN): 222490603

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2015-01-01 JOSEPH S. ROTH JOSEPH S. ROTH 2016-08-01
505 2014-01-01 JOSEPH S. ROTH JOSEPH S. ROTH 2015-10-13
505 2013-01-01 JOSEPH S. ROTH JOSEPH S. ROTH 2014-10-07
505 2012-01-01 JOSEPH S. ROTH JOSEPH S. ROTH 2013-10-11
505 2011-01-01 JOSEPH S. ROTH JOSEPH S. ROTH 2012-10-08
505 2010-01-01 DEBRA SANTANGELO DEBRA SANTANGELO 2011-10-13
505 2009-01-01 DEBRA SANTANGELO DEBRA SANTANGELO 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
505	2015-01-01	JOSEPH S. ROTH	JOSEPH S. ROTH	2016-08-01
505	2014-01-01	JOSEPH S. ROTH	JOSEPH S. ROTH	2015-10-13
505	2013-01-01	JOSEPH S. ROTH	JOSEPH S. ROTH	2014-10-07
505	2012-01-01	JOSEPH S. ROTH	JOSEPH S. ROTH	2013-10-11
505	2011-01-01	JOSEPH S. ROTH	JOSEPH S. ROTH	2012-10-08
505	2010-01-01	DEBRA SANTANGELO	DEBRA SANTANGELO	2011-10-13
505	2009-01-01	DEBRA SANTANGELO	DEBRA SANTANGELO	2010-10-13

Plan Statistics for NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN

401k plan membership statisitcs for NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN

Measure Date Value
2015: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 0
Total participants 2015-01-01 0
2014: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 102
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 2
Total of all active and inactive participants 2014-01-01 105
Total participants 2014-01-01 105
2013: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 105
Number of retired or separated participants receiving benefits 2013-01-01 5
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 112
Total participants 2013-01-01 112
2012: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 113
Number of retired or separated participants receiving benefits 2012-01-01 10
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 123
Total participants 2012-01-01 123
2011: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 120
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 1
Total of all active and inactive participants 2011-01-01 123
Total participants 2011-01-01 123
2010: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 130
Number of retired or separated participants receiving benefits 2010-01-01 5
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 135
Number of participants with account balances 2010-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 126
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 8
Total of all active and inactive participants 2009-01-01 135
Total participants 2009-01-01 135

Measure	Date	Value
2015: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	0
Total participants	2015-01-01	0
2014: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	102
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	2
Total of all active and inactive participants	2014-01-01	105
Total participants	2014-01-01	105
2013: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	105
Number of retired or separated participants receiving benefits	2013-01-01	5
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	112
Total participants	2013-01-01	112
2012: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	113
Number of retired or separated participants receiving benefits	2012-01-01	10
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	123
Total participants	2012-01-01	123
2011: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	120
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	1
Total of all active and inactive participants	2011-01-01	123
Total participants	2011-01-01	123
2010: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	130
Number of retired or separated participants receiving benefits	2010-01-01	5
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	135
Number of participants with account balances	2010-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	126
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	8
Total of all active and inactive participants	2009-01-01	135
Total participants	2009-01-01	135

Form 5500 Responses for NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN

2015: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	This submission is the final filing	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL 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: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL 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: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL 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: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL 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
2010: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: NEW JERSEY ORGAN AND TISSUE SHARING NETWORK EMPLOYEE MEDICAL 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

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12060279

Policy instance

Insurance contract or identification number	12060279
Number of Individuals Covered	127
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $943
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $943
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

SHRNO-001

Policy instance

Insurance contract or identification number	SHRNO-001
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 $521
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $521
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	117
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $65,789
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,311,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,789
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	117
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,399
Welfare Benefit Premiums Paid to Carrier	USD $287,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,399
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12060279

Policy instance

Insurance contract or identification number	12060279
Number of Individuals Covered	113
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $925
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $925
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	103
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $66,492
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,327,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,492
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

SHRNO-001

Policy instance

Insurance contract or identification number	SHRNO-001
Number of Individuals Covered	160
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $521
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $521
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	103
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,629
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $232,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,629
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12060279

Policy instance

Insurance contract or identification number	12060279
Number of Individuals Covered	131
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $943
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $943
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

SHRNO-001

Policy instance

Insurance contract or identification number	SHRNO-001
Number of Individuals Covered	160
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $695
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $695
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	108
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $33,306
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,412,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,306
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	108
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,508
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $246,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,508
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12060279

Policy instance

Insurance contract or identification number	12060279
Number of Individuals Covered	135
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $955
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $955
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

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

Policy contract number

NS16797

Policy instance

Insurance contract or identification number	NS16797
Number of Individuals Covered	289
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $93,770
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,883,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,770
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

SHRNO-001

Policy instance

Insurance contract or identification number	SHRNO-001
Number of Individuals Covered	178
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $434
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $434
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT/BROKER
Insurance broker organization code?	3
Insurance broker name	A & A BENEFIT CONSULTANTS, INC.

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

SHRNO-001

Policy instance

Insurance contract or identification number	SHRNO-001
Number of Individuals Covered	178
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $584
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12060279

Policy instance

Insurance contract or identification number	12060279
Number of Individuals Covered	134
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $967
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,089
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

NS16797

Policy instance

Insurance contract or identification number	NS16797
Number of Individuals Covered	293
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $66,281
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,623,587
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

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	132
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $14,455
Total amount of fees paid to insurance company	USD $0
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $290,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12060279

Policy instance

Insurance contract or identification number	12060279
Number of Individuals Covered	142
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $963
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,996
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

84942

Policy instance

Insurance contract or identification number	84942
Number of Individuals Covered	133
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $77,300
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,537,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

SHRNO-001

Policy instance

Insurance contract or identification number	SHRNO-001
Number of Individuals Covered	178
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $636
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,297
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NEW JERSEY ORGAN AND TISSUE SHARING NETWORK, INC.
Employer identification number (EIN):	222490603
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners