401k Plan data: BIRMINGHAM HEART CLINIC CAFETERIA PLAN plan

BIRMINGHAM HEART CLINIC CAFETERIA PLAN 401k Plan overview

Plan Name	BIRMINGHAM HEART CLINIC CAFETERIA PLAN
Plan identification number	502

BIRMINGHAM HEART CLINIC CAFETERIA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Other welfare benefit cover

401k Sponsoring company profile

BIRMINGHAM HEART CLINIC, P.C. has sponsored the creation of one or more 401k plans.

Company Name: BIRMINGHAM HEART CLINIC, P.C.

Employer identification number (EIN): 631119002

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BIRMINGHAM HEART CLINIC CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 RYAN LUCHNER 2023-10-05
502 2021-01-01 RYAN LUCHNER 2022-06-27
502 2020-01-01 TONYA WHITE 2021-07-21
502 2019-01-01 TONYA WHITE 2020-07-27
502 2018-01-01 TONYA WHITE 2020-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-01-01	RYAN LUCHNER	2023-10-05
502	2021-01-01	RYAN LUCHNER	2022-06-27
502	2020-01-01	TONYA WHITE	2021-07-21
502	2019-01-01	TONYA WHITE	2020-07-27
502	2018-01-01	TONYA WHITE	2020-07-27

Plan Statistics for BIRMINGHAM HEART CLINIC CAFETERIA PLAN

401k plan membership statisitcs for BIRMINGHAM HEART CLINIC CAFETERIA PLAN

Measure Date Value
2022: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 121
Total of all active and inactive participants 2022-01-01 121
2021: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 120
Total of all active and inactive participants 2021-01-01 120
2020: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 116
Total of all active and inactive participants 2020-01-01 116
2019: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 118
Total of all active and inactive participants 2019-01-01 118
2018: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 110
Total of all active and inactive participants 2018-01-01 110

Measure	Date	Value
2022: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	121
Total of all active and inactive participants	2022-01-01	121
2021: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	120
Total of all active and inactive participants	2021-01-01	120
2020: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	116
Total of all active and inactive participants	2020-01-01	116
2019: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	118
Total of all active and inactive participants	2019-01-01	118
2018: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	110
Total of all active and inactive participants	2018-01-01	110

Form 5500 Responses for BIRMINGHAM HEART CLINIC CAFETERIA PLAN

2022: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: BIRMINGHAM HEART CLINIC CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CANOPY INSURANCE CORP (National Association of Insurance Commissioners NAIC id number: 79057 )

Policy contract number

SBS0003168/3168

Policy instance

Insurance contract or identification number	SBS0003168/3168
Number of Individuals Covered	114
Insurance policy start date	2022-06-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,116
Total amount of fees paid to insurance company	USD $0
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 $1,116
Insurance broker organization code?	3

AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 )

Policy contract number

GAPAGI-3012

Policy instance

Insurance contract or identification number	GAPAGI-3012
Number of Individuals Covered	109
Insurance policy start date	2022-04-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $47,101
Total amount of fees paid to insurance company	USD $0
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 $24,490
Insurance broker organization code?	3

AMERICOMP BENEFITS (National Association of Insurance Commissioners NAIC id number: 52421 )

Policy contract number

ABI1075

Policy instance

Insurance contract or identification number	ABI1075
Number of Individuals Covered	50
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,495
Other welfare benefits provided	DEPENDENT CARE & FLEXIBLE SPENDING
Welfare Benefit Premiums Paid to Carrier	USD $78,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2495
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 )

Policy contract number

1161

Policy instance

Insurance contract or identification number	1161
Number of Individuals Covered	242
Insurance policy start date	2022-01-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $11,224
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,483
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

0044694

Policy instance

Insurance contract or identification number	0044694
Number of Individuals Covered	260
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

34721

Policy instance

Insurance contract or identification number	34721
Number of Individuals Covered	113
Insurance policy start date	2022-01-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $803
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $803
Insurance broker organization code?	3

CANOPY INSURANCE CORP (National Association of Insurance Commissioners NAIC id number: 79057 )

Policy contract number

SBS0003168/3168

Policy instance

Insurance contract or identification number	SBS0003168/3168
Number of Individuals Covered	123
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,015
Total amount of fees paid to insurance company	USD $0
Dental 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 $8,015
Insurance broker organization code?	3

SOUTHLAND DENTAL CORP (National Association of Insurance Commissioners NAIC id number: 16631 )

Policy contract number

SBS0003168

Policy instance

Insurance contract or identification number	SBS0003168
Number of Individuals Covered	117
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,444
Total amount of fees paid to insurance company	USD $0
Dental 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 $7,444
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

34721

Policy instance

Insurance contract or identification number	34721
Number of Individuals Covered	111
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,832
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,832
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

0044694

Policy instance

Insurance contract or identification number	0044694
Number of Individuals Covered	250
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 )

Policy contract number

1161

Policy instance

Insurance contract or identification number	1161
Number of Individuals Covered	253
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $43,420
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $206,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,946
Insurance broker organization code?	3

AMERICOMP BENEFITS (National Association of Insurance Commissioners NAIC id number: 52421 )

Policy contract number

ABI1075

Policy instance

Insurance contract or identification number	ABI1075
Number of Individuals Covered	47
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,495
Other welfare benefits provided	DEPENDENT CARE & FLEXIBLE SPENDING
Welfare Benefit Premiums Paid to Carrier	USD $77,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2495
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

AMERICOMP BENEFITS (National Association of Insurance Commissioners NAIC id number: 52421 )

Policy contract number

ABI1075

Policy instance

Insurance contract or identification number	ABI1075
Number of Individuals Covered	51
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,745
Other welfare benefits provided	DEPENDENT CARE & FLEXIBLE SPENDING
Welfare Benefit Premiums Paid to Carrier	USD $87,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2745
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )

Policy contract number

40042

Policy instance

Insurance contract or identification number	40042
Number of Individuals Covered	228
Insurance policy start date	2020-01-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $6,734
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,285

GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 )

Policy contract number

1161

Policy instance

Insurance contract or identification number	1161
Number of Individuals Covered	239
Insurance policy start date	2020-03-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $34,463
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,975
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

0044694

Policy instance

Insurance contract or identification number	0044694
Number of Individuals Covered	238
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

34721

Policy instance

Insurance contract or identification number	34721
Number of Individuals Covered	99
Insurance policy start date	2020-12-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,441
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,441
Insurance broker organization code?	3

SOUTHLAND DENTAL CORP (National Association of Insurance Commissioners NAIC id number: 16631 )

Policy contract number

SBS0003168

Policy instance

Insurance contract or identification number	SBS0003168
Number of Individuals Covered	108
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,167
Total amount of fees paid to insurance company	USD $0
Dental 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 $6,167
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

34721

Policy instance

Insurance contract or identification number	34721
Number of Individuals Covered	98
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,475
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,475
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

0044694

Policy instance

Insurance contract or identification number	0044694
Number of Individuals Covered	223
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 )

Policy contract number

60063

Policy instance

Insurance contract or identification number	60063
Number of Individuals Covered	227
Insurance policy start date	2019-01-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $6,222
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,959
Insurance broker organization code?	3

ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )

Policy contract number

40042

Policy instance

Insurance contract or identification number	40042
Number of Individuals Covered	222
Insurance policy start date	2019-03-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $32,732
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $148,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,829

AMERICOMP BENEFITS (National Association of Insurance Commissioners NAIC id number: 52421 )

Policy contract number

ABI1075

Policy instance

Insurance contract or identification number	ABI1075
Number of Individuals Covered	45
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,630
Other welfare benefits provided	DEPENDENT CARE & FLEXIBLE SPENDING
Welfare Benefit Premiums Paid to Carrier	USD $84,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2630
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

SOUTHLAND NATIONAL INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 79057 )

Policy contract number

SOUTHLAND 3168

Policy instance

Insurance contract or identification number	SOUTHLAND 3168
Number of Individuals Covered	111
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,946
Total amount of fees paid to insurance company	USD $0
Dental 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 $6,946
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

34721

Policy instance

Insurance contract or identification number	34721
Number of Individuals Covered	87
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,510
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,510
Insurance broker organization code?	3

GUARANTEED TRUST LIFE (National Association of Insurance Commissioners NAIC id number: 64211 )

Policy contract number

GTL AL38

Policy instance

Insurance contract or identification number	GTL AL38
Number of Individuals Covered	126
Insurance policy start date	2018-01-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $7,720
Total amount of fees paid to insurance company	USD $5,713
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,405
Insurance broker organization code?	3
Amount paid for insurance broker fees	2362
Additional information about fees paid to insurance broker	SERVICE FEES

MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 )

Policy contract number

60063

Policy instance

Insurance contract or identification number	60063
Number of Individuals Covered	231
Insurance policy start date	2018-03-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $27,871
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,736
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

0044694

Policy instance

Insurance contract or identification number	0044694
Number of Individuals Covered	234
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICOMP BENEFITS (National Association of Insurance Commissioners NAIC id number: 52421 )

Policy contract number

ABI1075

Policy instance

Insurance contract or identification number	ABI1075
Number of Individuals Covered	37
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,295
Other welfare benefits provided	DEPENDENT CARE & FLEXIBLE SPENDING
Welfare Benefit Premiums Paid to Carrier	USD $60,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2295
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

SOUTHLAND NATIONAL INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 79057 )

Policy contract number

SOUTHLAND 3168

Policy instance

Insurance contract or identification number	SOUTHLAND 3168
Number of Individuals Covered	101
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,199
Total amount of fees paid to insurance company	USD $0
Dental 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 $7,199
Insurance broker organization code?	3

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Company Name:	BIRMINGHAM HEART CLINIC, P.C.
Employer identification number (EIN):	631119002
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)