401k Plan data: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC plan

UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 401k Plan overview

Plan Name	UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC
Plan identification number	502

UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 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

UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE INC has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE INC

Employer identification number (EIN): 592274759

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01
502 2015-01-01
502 2014-01-01
502 2013-01-01
502 2012-01-01 NANCY D. FRASHUER
502 2011-01-01 NANCY D FRASHUER
502 2010-01-01 NANCY D FRASHUER
502 2009-01-01 NANCY D FRASHUER

Plan Statistics for UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC

401k plan membership statisitcs for UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC

Measure Date Value
2016: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,615
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,457
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 1,457
2015: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,472
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,074
Total of all active and inactive participants 2015-01-01 1,074
2014: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,084
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,284
Total of all active and inactive participants 2014-01-01 1,284
2013: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,401
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,290
Number of retired or separated participants receiving benefits 2013-01-01 39
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 1,329
2012: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,416
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,394
Number of retired or separated participants receiving benefits 2012-01-01 7
Total of all active and inactive participants 2012-01-01 1,401
Total participants 2012-01-01 0
2011: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,323
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,385
Number of retired or separated participants receiving benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 1,395
Total participants 2011-01-01 1,395
2010: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,288
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,292
Number of retired or separated participants receiving benefits 2010-01-01 9
Total of all active and inactive participants 2010-01-01 1,301
Total participants 2010-01-01 1,301
2009: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,355
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,380
Number of retired or separated participants receiving benefits 2009-01-01 9
Total of all active and inactive participants 2009-01-01 1,389
Total participants 2009-01-01 1,389

Measure	Date	Value
2016: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,615
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,457
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	1,457
2015: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,472
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,074
Total of all active and inactive participants	2015-01-01	1,074
2014: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,084
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,284
Total of all active and inactive participants	2014-01-01	1,284
2013: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,401
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,290
Number of retired or separated participants receiving benefits	2013-01-01	39
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	1,329
2012: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,416
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,394
Number of retired or separated participants receiving benefits	2012-01-01	7
Total of all active and inactive participants	2012-01-01	1,401
Total participants	2012-01-01	0
2011: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,323
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,385
Number of retired or separated participants receiving benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	1,395
Total participants	2011-01-01	1,395
2010: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,288
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,292
Number of retired or separated participants receiving benefits	2010-01-01	9
Total of all active and inactive participants	2010-01-01	1,301
Total participants	2010-01-01	1,301
2009: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,355
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,380
Number of retired or separated participants receiving benefits	2009-01-01	9
Total of all active and inactive participants	2009-01-01	1,389
Total participants	2009-01-01	1,389

Form 5500 Responses for UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC

2016: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan 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: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan 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: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan 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: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan 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: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan 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: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 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: UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE, INC 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

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AN86

Policy instance

Insurance contract or identification number	GLUG0AN86
Number of Individuals Covered	1372
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,200
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $80,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,200
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

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

Policy contract number

XA0 - 001, 002

Policy instance

Insurance contract or identification number	XA0 - 001, 002
Number of Individuals Covered	2046
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,341
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,341
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AN86

Policy instance

Insurance contract or identification number	GVTL0AN86
Number of Individuals Covered	627
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,039
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $125,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,039
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0AN86

Policy instance

Insurance contract or identification number	GUC 0AN86
Number of Individuals Covered	917
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $19,107
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $477,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,107
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0150463

Policy instance

Insurance contract or identification number	0150463
Number of Individuals Covered	2537
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,225
Total amount of fees paid to insurance company	USD $1,964
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $720,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,225
Amount paid for insurance broker fees	1964
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AN86

Policy instance

Insurance contract or identification number	GLTD0AN86
Number of Individuals Covered	1139
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,800
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,800
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0150463

Policy instance

Insurance contract or identification number	0150463
Number of Individuals Covered	2435
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,528
Total amount of fees paid to insurance company	USD $9,860
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 $671,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,528
Amount paid for insurance broker fees	9860
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION.
Insurance broker organization code?	3
Insurance broker name	ELAN GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	910
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,929
Total amount of fees paid to insurance company	USD $5,625
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	PREFERRED CHOICE VOLUNTARY STD
Welfare Benefit Premiums Paid to Carrier	USD $373,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,929
Amount paid for insurance broker fees	5625
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	1321
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,007
Total amount of fees paid to insurance company	USD $1,921
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 $75,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,007
Amount paid for insurance broker fees	1921
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	680
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,121
Total amount of fees paid to insurance company	USD $3,296
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 VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $128,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,121
Amount paid for insurance broker fees	3296
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9839408

Policy instance

Insurance contract or identification number	9839408
Number of Individuals Covered	1904
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,188
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: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	1132
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,604
Total amount of fees paid to insurance company	USD $4,034
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 $140,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,604
Amount paid for insurance broker fees	4034
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	670
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,422
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $135,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,422
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	926
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,939
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	PREFERRED CHOICE VOLUNTARY STD
Welfare Benefit Premiums Paid to Carrier	USD $398,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,939
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	1293
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,174
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $79,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,174
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN86

Policy instance

Insurance contract or identification number	G000AN86
Number of Individuals Covered	1131
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,042
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,042
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0150463

Policy instance

Insurance contract or identification number	0150463
Number of Individuals Covered	2429
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,660
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 $697,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,660
Insurance broker organization code?	3
Insurance broker name	THE ELAN GROUP, INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V3182

Policy instance

Insurance contract or identification number	V3182
Number of Individuals Covered	1155
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $173,172
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $158,523
Insurance broker organization code?	3
Insurance broker name	FRANK P. DOHERTY

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9839408

Policy instance

Insurance contract or identification number	9839408
Number of Individuals Covered	1898
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9842212

Policy instance

Insurance contract or identification number	9842212
Number of Individuals Covered	9
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA
Welfare Benefit Premiums Paid to Carrier	USD $575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9839408

Policy instance

Insurance contract or identification number	9839408
Number of Individuals Covered	1967
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

FL-02036

Policy instance

Insurance contract or identification number	FL-02036
Number of Individuals Covered	1143
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $698,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

813295

Policy instance

Insurance contract or identification number	813295
Number of Individuals Covered	1412
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $817,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY OF NE (National Association of Insurance Commissioners NAIC id number: 12634 )

Policy contract number

VS3041

Policy instance

Insurance contract or identification number	VS3041
Number of Individuals Covered	813
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $919
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

813295

Policy instance

Insurance contract or identification number	813295
Number of Individuals Covered	1383
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,487
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $742,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

FL-02036

Policy instance

Insurance contract or identification number	FL-02036
Number of Individuals Covered	1113
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $664,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

64601

Policy instance

Insurance contract or identification number	64601
Number of Individuals Covered	865
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $37,950
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 $37,950
Insurance broker organization code?	3
Insurance broker name	COMBINED INSURANCE SERVICES

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

58398

Policy instance

Insurance contract or identification number	58398
Number of Individuals Covered	189
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,050
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 $12,050
Insurance broker organization code?	3
Insurance broker name	COMBINED INSURANCE SERVICES

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS3041

Policy instance

Insurance contract or identification number	VS3041
Number of Individuals Covered	1413
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,145
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,145
Insurance broker organization code?	3
Insurance broker name	HARDEN & ASSOCIATES, INC.

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

Policy contract number

813295

Policy instance

Insurance contract or identification number	813295
Number of Individuals Covered	1320
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $82,765
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $767,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,765
Insurance broker organization code?	3
Insurance broker name	HARDEN & ASSOCIATES, INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

FL-02036

Policy instance

Insurance contract or identification number	FL-02036
Number of Individuals Covered	1060
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $677,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	UNIVERSITY OF FLORIDA JACKSONVILLE HEALTHCARE INC
Employer identification number (EIN):	592274759
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)