401k Plan data: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN plan

NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number	501

NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 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 Other welfare benefit cover

401k Sponsoring company profile

NORTHEAST GEORGIA DIAGNOSTIC CLINIC, LLC has sponsored the creation of one or more 401k plans.

Company Name: NORTHEAST GEORGIA DIAGNOSTIC CLINIC, LLC

Employer identification number (EIN): 580656907

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

Additional information about NORTHEAST GEORGIA DIAGNOSTIC CLINIC, LLC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 970495

More information about NORTHEAST GEORGIA DIAGNOSTIC CLINIC, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 WILLIAM H. BEYER
501 2014-01-01 WILLIAM H. BEYER
501 2013-01-01 EMMETT FORRESTER
501 2012-01-01 EMMETT FORRESTER
501 2011-01-01 EMMETT FORRESTER
501 2010-01-01 EMMETT FORRESTER

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01	WILLIAM H. BEYER
501	2014-01-01	WILLIAM H. BEYER
501	2013-01-01	EMMETT FORRESTER
501	2012-01-01	EMMETT FORRESTER
501	2011-01-01	EMMETT FORRESTER
501	2010-01-01	EMMETT FORRESTER

Plan Statistics for NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2015: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 225
Total of all active and inactive participants 2015-01-01 225
Total participants 2015-01-01 0
2014: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 207
Total of all active and inactive participants 2014-01-01 207
Total participants 2014-01-01 0
2013: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 199
Total of all active and inactive participants 2013-01-01 199
Total participants 2013-01-01 0
2012: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 190
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 181
Total of all active and inactive participants 2012-01-01 181
Total participants 2012-01-01 0
2011: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 190
Total of all active and inactive participants 2011-01-01 190
Total participants 2011-01-01 190
2010: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 156
Total of all active and inactive participants 2010-01-01 156
Total participants 2010-01-01 156

Measure	Date	Value
2015: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	225
Total of all active and inactive participants	2015-01-01	225
Total participants	2015-01-01	0
2014: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	207
Total of all active and inactive participants	2014-01-01	207
Total participants	2014-01-01	0
2013: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	199
Total of all active and inactive participants	2013-01-01	199
Total participants	2013-01-01	0
2012: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	190
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	181
Total of all active and inactive participants	2012-01-01	181
Total participants	2012-01-01	0
2011: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	190
Total of all active and inactive participants	2011-01-01	190
Total participants	2011-01-01	190
2010: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	156
Total of all active and inactive participants	2010-01-01	156
Total participants	2010-01-01	156

Form 5500 Responses for NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN

2015: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT 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: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT 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: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT 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: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT 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
2010: NORTHEAST GEORGIA DIAGNOSTIC CLINIC EMPLOYEE HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30812

Policy instance

Insurance contract or identification number	HCL30812
Number of Individuals Covered	185
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

158865

Policy instance

Insurance contract or identification number	158865
Number of Individuals Covered	100
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,883
Total amount of fees paid to insurance company	USD $1,319
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,162
Insurance broker organization code?	3
Amount paid for insurance broker fees	1319
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker name	PLANSOURCE BENEFITS ADMIN INC

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

Policy contract number

158865

Policy instance

Insurance contract or identification number	158865
Number of Individuals Covered	225
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,708
Total amount of fees paid to insurance company	USD $3,575
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,712
Insurance broker organization code?	3
Amount paid for insurance broker fees	3575
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker name	PLANSOURCE BENEFITS ADMIN INC

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

Policy contract number

158865

Policy instance

Insurance contract or identification number	158865
Number of Individuals Covered	225
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,205
Total amount of fees paid to insurance company	USD $1,607
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,359
Insurance broker organization code?	3
Amount paid for insurance broker fees	1607
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker name	PLANSOURCE BENEFITS ADMIN INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

067720

Policy instance

Insurance contract or identification number	067720
Number of Individuals Covered	125
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $4,659
Total amount of fees paid to insurance company	USD $291
Other welfare benefits provided	LONG TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,659
Amount paid for insurance broker fees	291
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	LARRY K. STEPP

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

Policy contract number

006H369

Policy instance

Insurance contract or identification number	006H369
Number of Individuals Covered	166
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,850
Total amount of fees paid to insurance company	USD $1,147
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, VLNTARY CRITICAL ILLNESS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,850
Amount paid for insurance broker fees	1147
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	THE BENEFIT PLANNING GROUP

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

GR4868

Policy instance

Insurance contract or identification number	GR4868
Number of Individuals Covered	166
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $26,075
Total amount of fees paid to insurance company	USD $24,563
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,243
Amount paid for insurance broker fees	14288
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	THE BENEFIT PLANNING GROUP

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

Policy contract number

00463130

Policy instance

Insurance contract or identification number	00463130
Number of Individuals Covered	134
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,587
Total amount of fees paid to insurance company	USD $3,675
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,619
Amount paid for insurance broker fees	3675
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	THE BENEFIT PLANNING GROUP

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

067845

Policy instance

Insurance contract or identification number	067845
Number of Individuals Covered	89
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $2,965
Total amount of fees paid to insurance company	USD $504
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,139
Amount paid for insurance broker fees	302
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	LARRY K. STEPP

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

067720

Policy instance

Insurance contract or identification number	067720
Number of Individuals Covered	125
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $5,092
Total amount of fees paid to insurance company	USD $318
Other welfare benefits provided	LONG TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,998
Amount paid for insurance broker fees	187
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	LARRY K. STEPP

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

599524

Policy instance

Insurance contract or identification number	599524
Number of Individuals Covered	207
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $6,061
Total amount of fees paid to insurance company	USD $1,760
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,196
Amount paid for insurance broker fees	1022
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	LARRY K. STEPP

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

067721

Policy instance

Insurance contract or identification number	067721
Number of Individuals Covered	130
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $6,246
Total amount of fees paid to insurance company	USD $520
Other welfare benefits provided	LIFESTYLE ADD, LIFESTYLE LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,675
Amount paid for insurance broker fees	306
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	LARRY K. STEPP

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

Policy contract number

00463130

Policy instance

Insurance contract or identification number	00463130
Number of Individuals Covered	128
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,571
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,571
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403459

Policy instance

Insurance contract or identification number	403459
Number of Individuals Covered	168
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $28,664
Total amount of fees paid to insurance company	USD $23,063
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,408
Amount paid for insurance broker fees	15688
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	ARGUS HOLDINGS DBA ARGUS BENEFITS

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

067720

Policy instance

Insurance contract or identification number	067720
Number of Individuals Covered	136
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $5,131
Total amount of fees paid to insurance company	USD $109
Other welfare benefits provided	LONG TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,131
Amount paid for insurance broker fees	109
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

599524

Policy instance

Insurance contract or identification number	599524
Number of Individuals Covered	199
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $5,590
Total amount of fees paid to insurance company	USD $417
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,590
Amount paid for insurance broker fees	417
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

067721

Policy instance

Insurance contract or identification number	067721
Number of Individuals Covered	118
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $5,362
Total amount of fees paid to insurance company	USD $149
Other welfare benefits provided	LIFESTYLE ADD, LIFESTYLE LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,362
Amount paid for insurance broker fees	149
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC

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

Policy contract number

00463130

Policy instance

Insurance contract or identification number	00463130
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 $4,441
Total amount of fees paid to insurance company	USD $5,424
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7
Insurance broker organization code?	3
Amount paid for insurance broker fees	5424
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker name	NORTHWESTERN BENEFIT CORP OF GA

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

599524

Policy instance

Insurance contract or identification number	599524
Number of Individuals Covered	181
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $5,699
Total amount of fees paid to insurance company	USD $323
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $283
Insurance broker organization code?	3
Amount paid for insurance broker fees	323
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker name	NORTHWESTERN BENEFIT CORP OF GA

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00000067720

Policy instance

Insurance contract or identification number	00000067720
Number of Individuals Covered	127
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $5,580
Total amount of fees paid to insurance company	USD $85
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $912
Insurance broker organization code?	3
Amount paid for insurance broker fees	85
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker name	RESOURCE ALLIANCE LLC

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403459

Policy instance

Insurance contract or identification number	403459
Number of Individuals Covered	140
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $24,731
Total amount of fees paid to insurance company	USD $21,088
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,208
Amount paid for insurance broker fees	3613
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	RESOURCE ALLIANCE, LLC

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

Policy contract number

00463130

Policy instance

Insurance contract or identification number	00463130
Number of Individuals Covered	122
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,475
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403459

Policy instance

Insurance contract or identification number	403459
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 $26,771
Total amount of fees paid to insurance company	USD $22,700
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00000067720

Policy instance

Insurance contract or identification number	00000067720
Number of Individuals Covered	125
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $5,143
Total amount of fees paid to insurance company	USD $321
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

599524

Policy instance

Insurance contract or identification number	599524
Number of Individuals Covered	190
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $6,070
Total amount of fees paid to insurance company	USD $1,792
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

UP-AFBD

Policy instance

Insurance contract or identification number	UP-AFBD
Number of Individuals Covered	156
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $26,662
Total amount of fees paid to insurance company	USD $23,712
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,662
Amount paid for insurance broker fees	23712
Additional information about fees paid to insurance broker	CONSULTANT'S FEES
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN BENEFIT CORP OF GA

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Company Name:	NORTHEAST GEORGIA DIAGNOSTIC CLINIC, LLC
Employer identification number (EIN):	580656907
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	970495