401k Plan data: AHF INSURANCE PLANS plan

AHF INSURANCE PLANS 401k Plan overview

Plan Name	AHF INSURANCE PLANS
Plan identification number	501

AHF INSURANCE PLANS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

AMERICAN HEALTH FOUNDATION, INC. has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN HEALTH FOUNDATION, INC.

Employer identification number (EIN): 311311729

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about AMERICAN HEALTH FOUNDATION, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2009-09-24

Company Identification Number: N09000009367

Legal Registered Office Address: 10240 SW 56 ST

Miami

33165

More information about AMERICAN HEALTH FOUNDATION, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AHF INSURANCE PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2017-10-27
501 2016-01-01 J MICHAEL HAEMMERLE 2017-10-10
501 2015-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2016-10-17
501 2015-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2016-12-07
501 2014-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2015-10-15
501 2014-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2015-10-21
501 2013-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2014-10-15
501 2012-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2013-09-26
501 2011-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2012-10-08
501 2010-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2011-10-13
501 2009-01-01 J MICHAEL HAEMMERLE J MICHAEL HAEMMERLE 2010-10-07

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2017-10-27
501	2016-01-01		J MICHAEL HAEMMERLE	2017-10-10
501	2015-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2016-10-17
501	2015-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2016-12-07
501	2014-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2015-10-15
501	2014-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2015-10-21
501	2013-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2014-10-15
501	2012-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2013-09-26
501	2011-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2012-10-08
501	2010-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2011-10-13
501	2009-01-01	J MICHAEL HAEMMERLE	J MICHAEL HAEMMERLE	2010-10-07

Plan Statistics for AHF INSURANCE PLANS

401k plan membership statisitcs for AHF INSURANCE PLANS

Measure Date Value
2016: AHF INSURANCE PLANS 2016 401k membership
Total participants, beginning-of-year 2016-01-01 446
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 370
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 370
2015: AHF INSURANCE PLANS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 498
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 446
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 2015-01-01 446
2014: AHF INSURANCE PLANS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 498
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
2013: AHF INSURANCE PLANS 2013 401k membership
Total participants, beginning-of-year 2013-01-01 584
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 498
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 498
2012: AHF INSURANCE PLANS 2012 401k membership
Total participants, beginning-of-year 2012-01-01 603
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 584
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 584
2011: AHF INSURANCE PLANS 2011 401k membership
Total participants, beginning-of-year 2011-01-01 573
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 603
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 603
2010: AHF INSURANCE PLANS 2010 401k membership
Total participants, beginning-of-year 2010-01-01 607
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 573
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 573
2009: AHF INSURANCE PLANS 2009 401k membership
Total participants, beginning-of-year 2009-01-01 601
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 607
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 607

Measure	Date	Value
2016: AHF INSURANCE PLANS 2016 401k membership
Total participants, beginning-of-year	2016-01-01	446
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	370
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	370
2015: AHF INSURANCE PLANS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	498
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	446
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	446
2014: AHF INSURANCE PLANS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	498
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
2013: AHF INSURANCE PLANS 2013 401k membership
Total participants, beginning-of-year	2013-01-01	584
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	498
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	498
2012: AHF INSURANCE PLANS 2012 401k membership
Total participants, beginning-of-year	2012-01-01	603
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	584
Number of retired or separated participants receiving benefits	2012-01-01	0
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	584
2011: AHF INSURANCE PLANS 2011 401k membership
Total participants, beginning-of-year	2011-01-01	573
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	603
Number of retired or separated participants receiving benefits	2011-01-01	0
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	603
2010: AHF INSURANCE PLANS 2010 401k membership
Total participants, beginning-of-year	2010-01-01	607
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	573
Number of retired or separated participants receiving benefits	2010-01-01	0
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	573
2009: AHF INSURANCE PLANS 2009 401k membership
Total participants, beginning-of-year	2009-01-01	601
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	607
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	607

Form 5500 Responses for AHF INSURANCE PLANS

2016: AHF INSURANCE PLANS 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: AHF INSURANCE PLANS 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: AHF INSURANCE PLANS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: AHF INSURANCE PLANS 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: AHF INSURANCE PLANS 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: AHF INSURANCE PLANS 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: AHF INSURANCE PLANS 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: AHF INSURANCE PLANS 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

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

007094305

Policy instance

Insurance contract or identification number	007094305
Number of Individuals Covered	12
Insurance policy start date	2015-06-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,960
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,960
Insurance broker organization code?	3
Insurance broker name	ANDERSON & KIME EMPLOYEE BENEFITS

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

Policy contract number

0902229

Policy instance

Insurance contract or identification number	0902229
Number of Individuals Covered	87
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $42,042
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,188,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $42,042
Insurance broker organization code?	3
Insurance broker name	JANET L HORSTMAN

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 )

Policy contract number

0848103HNO

Policy instance

Insurance contract or identification number	0848103HNO
Number of Individuals Covered	76
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $33,385
Total amount of fees paid to insurance company	USD $98
Welfare Benefit Premiums Paid to Carrier	USD $528,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	98
Additional information about fees paid to insurance broker	ELIGIBLE INDIRECT COMPENSATION
Commission paid to Insurance Broker	USD $33,385
Insurance broker name	BROWN & BROWN OF PA INC DBA

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
Number of Individuals Covered	84
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,620
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,612
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	INDEPENDENCE PLANNING GROUP

HUMANA INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	65
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,114
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,114
Insurance broker organization code?	3
Insurance broker name	MARK T HORSTMAN

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5473459

Policy instance

Insurance contract or identification number	5473459
Number of Individuals Covered	74
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,014
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $2,014
Insurance broker organization code?	3
Insurance broker name	MARK HORSTMAN

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

Policy contract number

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	80
Insurance policy start date	2014-06-30
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $22,764
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $593,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,498
Insurance broker organization code?	3
Insurance broker name	JANET HORSTMAN

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

PC 00007096

Policy instance

Insurance contract or identification number	PC 00007096
Number of Individuals Covered	110
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,916
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,916
Insurance broker organization code?	3
Insurance broker name	MARK HORSTMAN

HUMANA INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	69
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,029
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 )

Policy contract number

0848103HNO

Policy instance

Insurance contract or identification number	0848103HNO
Number of Individuals Covered	80
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $28,459
Total amount of fees paid to insurance company	USD $47
Welfare Benefit Premiums Paid to Carrier	USD $482,492
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

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	80
Insurance policy start date	2014-06-30
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $22,764
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $593,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,764
Insurance broker organization code?	3
Insurance broker name	JANET L HORSTMAN

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

007094303

Policy instance

Insurance contract or identification number	007094303
Number of Individuals Covered	11
Insurance policy start date	2014-06-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,520
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,520
Insurance broker organization code?	3
Insurance broker name	ANDERSON & KIME EMPLOYEE BENEFITS

HUMANA INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	69
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,029
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,029
Insurance broker organization code?	3
Insurance broker name	MARK T HORSTMAN

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 )

Policy contract number

0848103HNO

Policy instance

Insurance contract or identification number	0848103HNO
Number of Individuals Covered	80
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $28,459
Total amount of fees paid to insurance company	USD $47
Welfare Benefit Premiums Paid to Carrier	USD $482,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	47
Additional information about fees paid to insurance broker	ELIGIBLE INDIRECT COMPENSATION
Commission paid to Insurance Broker	USD $28,459
Insurance broker name	BROWN & BROWN OF PA INC DBA

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
Number of Individuals Covered	71
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,212
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,206
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	INDEPENDENCE PLANNING GROUP

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
Number of Individuals Covered	71
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,212
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,772
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

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $15,498
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $379,431
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

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	104
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $39,005
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $961,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,005
Insurance broker organization code?	3
Insurance broker name	JANET HORSTMAN

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
Number of Individuals Covered	61
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,059
Total amount of fees paid to insurance company	USD $265
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,054
Amount paid for insurance broker fees	265
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	INDEPENDENCE PLANNING GROUP

HUMANA INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	63
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,128
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,128
Insurance broker organization code?	3
Insurance broker name	MARK T HORSTMAN

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

105157

Policy instance

Insurance contract or identification number	105157
Number of Individuals Covered	75
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,661
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,661
Insurance broker organization code?	3
Insurance broker name	HARTMAN EMPLOYEE BENEFITS INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7096

Policy instance

Insurance contract or identification number	7096
Number of Individuals Covered	118
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,265
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,265
Insurance broker organization code?	3
Insurance broker name	MARK HORSTMAN

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

Policy contract number

848103

Policy instance

Insurance contract or identification number	848103
Number of Individuals Covered	77
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,455
Total amount of fees paid to insurance company	USD $265
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,455
Amount paid for insurance broker fees	265
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF PA INC

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

Policy contract number

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	129
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $38,803
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $970,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,803
Insurance broker organization code?	3
Insurance broker name	JANET HORSTMAN

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7096

Policy instance

Insurance contract or identification number	7096
Number of Individuals Covered	129
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,271
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,271
Insurance broker organization code?	3
Insurance broker name	MARK HORSTMAN

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000834512

Policy instance

Insurance contract or identification number	0000834512
Number of Individuals Covered	117
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $19,325
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $364,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,325
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF PENNA INC

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
Number of Individuals Covered	65
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,282
Total amount of fees paid to insurance company	USD $37
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,276
Amount paid for insurance broker fees	37
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	INDEPENDENCE PLANNING GROUP

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	70
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,105
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,105
Insurance broker organization code?	3
Insurance broker name	MARK T HORSTMAN

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

105157

Policy instance

Insurance contract or identification number	105157
Number of Individuals Covered	74
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,773
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $328,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,773
Insurance broker organization code?	3
Insurance broker name	HARTMAN EMPLOYEE BENEFITS INC

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

105157

Policy instance

Insurance contract or identification number	105157
Number of Individuals Covered	59
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,672
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $316,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	66
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,384
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
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 $1,305
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,612
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

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	120
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $39,242
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $981,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000834512

Policy instance

Insurance contract or identification number	0000834512
Number of Individuals Covered	146
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $23,562
Total amount of fees paid to insurance company	USD $776
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $497,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7096

Policy instance

Insurance contract or identification number	7096
Number of Individuals Covered	141
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,224
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,968
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

401251

Policy instance

Insurance contract or identification number	401251
Number of Individuals Covered	135
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $38,272
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $956,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000834512

Policy instance

Insurance contract or identification number	0000834512
Number of Individuals Covered	62
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $22,872
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $415,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00305518

Policy instance

Insurance contract or identification number	00305518
Number of Individuals Covered	81
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,565
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

563846

Policy instance

Insurance contract or identification number	563846
Number of Individuals Covered	76
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,568
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7096

Policy instance

Insurance contract or identification number	7096
Number of Individuals Covered	155
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,264
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

105157

Policy instance

Insurance contract or identification number	105157
Number of Individuals Covered	64
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $13,436
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $328,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	AMERICAN HEALTH FOUNDATION, INC.
Employer identification number (EIN):	311311729
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2009-09-24
Company Identification Number:	N09000009367
Legal Registered Office Address:	10240 SW 56 ST Miami 33165