401k Plan data: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN plan

ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 401k Plan overview

Plan Name	ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN
Plan identification number	501

ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN Benefits

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

401k Sponsoring company profile

ALLCARE CLINICAL ASSOCIATES P.A. has sponsored the creation of one or more 401k plans.

Company Name: ALLCARE CLINICAL ASSOCIATES P.A.

Employer identification number (EIN): 560962697

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 NANCY DEXTER
501 2011-01-01 NANCY DEXTER
501 2009-01-01 DAVID PERRY
501 2009-01-01 DAVID PERRY
501 2009-01-01 DAVID PERRY

Plan Statistics for ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN

401k plan membership statisitcs for ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN

Measure Date Value
2016: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 186
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 50
Total of all active and inactive participants 2016-01-01 50
Total participants 2016-01-01 50
2015: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 178
Number of retired or separated participants receiving benefits 2015-01-01 8
Total of all active and inactive participants 2015-01-01 186
2014: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 196
Total of all active and inactive participants 2014-01-01 196
Total participants 2014-01-01 196
2013: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 204
Total of all active and inactive participants 2013-01-01 204
2012: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 160
Total of all active and inactive participants 2012-01-01 160
2011: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 160
Total of all active and inactive participants 2011-01-01 160
2009: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 162
Total of all active and inactive participants 2009-01-01 162
Total participants 2009-01-01 162

Measure	Date	Value
2016: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	186
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	50
Total of all active and inactive participants	2016-01-01	50
Total participants	2016-01-01	50
2015: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	178
Number of retired or separated participants receiving benefits	2015-01-01	8
Total of all active and inactive participants	2015-01-01	186
2014: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	196
Total of all active and inactive participants	2014-01-01	196
Total participants	2014-01-01	196
2013: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	204
Total of all active and inactive participants	2013-01-01	204
2012: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	160
Total of all active and inactive participants	2012-01-01	160
2011: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	160
Total of all active and inactive participants	2011-01-01	160
2009: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	162
Total of all active and inactive participants	2009-01-01	162
Total participants	2009-01-01	162

Form 5500 Responses for ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN

2016: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: ALLCARE CLINICAL ASSOCIATES, P.A. CAFETERIA PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	178
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $2,844
Total amount of fees paid to insurance company	USD $321
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,844
Amount paid for insurance broker fees	321
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000 10

Policy instance

Insurance contract or identification number	000400001000 10
Number of Individuals Covered	71
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $10,457
Total amount of fees paid to insurance company	USD $1,240
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $52,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,457
Amount paid for insurance broker fees	1240
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010120311 00

Policy instance

Insurance contract or identification number	000010120311 00
Number of Individuals Covered	164
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $58,884
Total amount of fees paid to insurance company	USD $6,383
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $294,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,884
Amount paid for insurance broker fees	6383
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400002000 02523

Policy instance

Insurance contract or identification number	400002000 02523
Number of Individuals Covered	69
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $13,978
Total amount of fees paid to insurance company	USD $1,455
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $69,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,978
Amount paid for insurance broker fees	1455
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

404002217 00000

Policy instance

Insurance contract or identification number	404002217 00000
Number of Individuals Covered	29
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,598
Total amount of fees paid to insurance company	USD $190
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,598
Amount paid for insurance broker fees	190
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

50173

Policy instance

Insurance contract or identification number	50173
Number of Individuals Covered	176
Insurance policy start date	2015-01-31
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $22,182
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $148,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,785
Insurance broker organization code?	3
Insurance broker name	ISBI HOLDING INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400002000 02523

Policy instance

Insurance contract or identification number	400002000 02523
Number of Individuals Covered	91
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,547
Total amount of fees paid to insurance company	USD $647
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $72,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,547
Amount paid for insurance broker fees	647
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010120311 00

Policy instance

Insurance contract or identification number	000010120311 00
Number of Individuals Covered	187
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $64,071
Total amount of fees paid to insurance company	USD $3,056
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $320,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,071
Amount paid for insurance broker fees	3056
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000 10

Policy instance

Insurance contract or identification number	000400001000 10
Number of Individuals Covered	89
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $12,402
Total amount of fees paid to insurance company	USD $558
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
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $62,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,402
Amount paid for insurance broker fees	558
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	196
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $3,211
Total amount of fees paid to insurance company	USD $150
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
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,211
Amount paid for insurance broker fees	150
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

751328

Policy instance

Insurance contract or identification number	751328
Number of Individuals Covered	186
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $23,166
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 $160,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,834
Insurance broker organization code?	3
Insurance broker name	ISBI HOLDING INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

404002217 00000

Policy instance

Insurance contract or identification number	404002217 00000
Number of Individuals Covered	31
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,493
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
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,493
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400002000 02523

Policy instance

Insurance contract or identification number	400002000 02523
Number of Individuals Covered	88
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,936
Total amount of fees paid to insurance company	USD $287
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY WI
Welfare Benefit Premiums Paid to Carrier	USD $64,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,936
Amount paid for insurance broker fees	287
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

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

Policy contract number

730874

Policy instance

Insurance contract or identification number	730874
Number of Individuals Covered	375
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,421
Total amount of fees paid to insurance company	USD $51,121
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 $1,240,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,421
Amount paid for insurance broker fees	51121
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

404002217 00000

Policy instance

Insurance contract or identification number	404002217 00000
Number of Individuals Covered	26
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $871
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
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $4,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $871
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 10602

Policy instance

Insurance contract or identification number	400001000 10602
Number of Individuals Covered	176
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $11,167
Total amount of fees paid to insurance company	USD $263
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
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $55,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,167
Amount paid for insurance broker fees	263
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	199
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,990
Total amount of fees paid to insurance company	USD $68
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
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,990
Amount paid for insurance broker fees	68
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

6994X9

Policy instance

Insurance contract or identification number	6994X9
Number of Individuals Covered	392
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,903
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 $147,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,903
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120311 00000

Policy instance

Insurance contract or identification number	010120311 00000
Number of Individuals Covered	189
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $61,126
Total amount of fees paid to insurance company	USD $1,425
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $305,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,126
Amount paid for insurance broker fees	1425
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

6994X9

Policy instance

Insurance contract or identification number	6994X9
Number of Individuals Covered	306
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $6,839
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 $118,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,839
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68047 )

Policy contract number

404002217 00000

Policy instance

Insurance contract or identification number	404002217 00000
Number of Individuals Covered	16
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $558
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
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $558
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

730874

Policy instance

Insurance contract or identification number	730874
Number of Individuals Covered	301
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $49,282
Total amount of fees paid to insurance company	USD $1,550
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 $1,146,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,282
Amount paid for insurance broker fees	1550
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400002000 02523

Policy instance

Insurance contract or identification number	400002000 02523
Number of Individuals Covered	71
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,492
Total amount of fees paid to insurance company	USD $2,465
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY WI
Welfare Benefit Premiums Paid to Carrier	USD $57,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,492
Amount paid for insurance broker fees	2465
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120311 00000

Policy instance

Insurance contract or identification number	010120311 00000
Number of Individuals Covered	166
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $56,992
Total amount of fees paid to insurance company	USD $11,250
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $284,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,992
Amount paid for insurance broker fees	11250
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 10602

Policy instance

Insurance contract or identification number	400001000 10602
Number of Individuals Covered	142
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,510
Total amount of fees paid to insurance company	USD $2,250
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
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $52,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,510
Amount paid for insurance broker fees	2250
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	174
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,710
Total amount of fees paid to insurance company	USD $594
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
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,710
Amount paid for insurance broker fees	594
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES, INC.

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

6994X9

Policy instance

Insurance contract or identification number	6994X9
Number of Individuals Covered	284
Insurance policy start date	2011-08-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,995
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 $53,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	159
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $2,644
Total amount of fees paid to insurance company	USD $268
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
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 10602

Policy instance

Insurance contract or identification number	400001000 10602
Number of Individuals Covered	138
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $9,948
Total amount of fees paid to insurance company	USD $908
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
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $49,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	152
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $55,627
Total amount of fees paid to insurance company	USD $5,000
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $278,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400002000 02523

Policy instance

Insurance contract or identification number	400002000 02523
Number of Individuals Covered	65
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $10,882
Total amount of fees paid to insurance company	USD $1,027
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY WI
Welfare Benefit Premiums Paid to Carrier	USD $54,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034163

Policy instance

Insurance contract or identification number	010-034163
Number of Individuals Covered	156
Insurance policy start date	2011-01-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $3,556
Total amount of fees paid to insurance company	USD $2,500
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 $71,119
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

730784

Policy instance

Insurance contract or identification number	730784
Number of Individuals Covered	268
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $37,960
Total amount of fees paid to insurance company	USD $1,836
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 $946,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034163

Policy instance

Insurance contract or identification number	010-034163
Number of Individuals Covered	345
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,410
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,410
Insurance broker organization code?	3
Insurance broker name	MARK III BROKERAGE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	157
Insurance policy start date	2010-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,689
Total amount of fees paid to insurance company	USD $45
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $13,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,689
Amount paid for insurance broker fees	45
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400002000 02523

Policy instance

Insurance contract or identification number	400002000 02523
Number of Individuals Covered	60
Insurance policy start date	2010-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,233
Total amount of fees paid to insurance company	USD $172
Other welfare benefits provided	VOLUNTARY WI
Welfare Benefit Premiums Paid to Carrier	USD $51,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,233
Amount paid for insurance broker fees	172
Additional information about fees paid to insurance broker	BORKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES INC

FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	65
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Other welfare benefits provided	FSA ADMINISTRATION
Welfare Benefit Premiums Paid to Carrier	USD $4,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	65
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Other welfare benefits provided	COBRA ADMINISTRATION
Welfare Benefit Premiums Paid to Carrier	USD $1,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010120310 00000

Policy instance

Insurance contract or identification number	010120310 00000
Number of Individuals Covered	149
Total amount of commissions paid to insurance broker	USD $55,441
Total amount of fees paid to insurance company	USD $928
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $277,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,441
Amount paid for insurance broker fees	928
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 10602

Policy instance

Insurance contract or identification number	400001000 10602
Number of Individuals Covered	137
Insurance policy start date	2010-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,876
Total amount of fees paid to insurance company	USD $148
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $44,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,876
Amount paid for insurance broker fees	148
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	JOSH WILLIAMS ENTERPRISES INC

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Company Name:	ALLCARE CLINICAL ASSOCIATES P.A.
Employer identification number (EIN):	560962697
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)