401k Plan data: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN plan

THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 401k Plan overview

Plan Name	THE BROWN PHYSICIAN'S, INC. WELFARE PLAN
Plan identification number	501

THE BROWN PHYSICIAN'S, INC. WELFARE 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

BROWN PHYSICIANS, INC. has sponsored the creation of one or more 401k plans.

Company Name: BROWN PHYSICIANS, INC.

Employer identification number (EIN): 821858635

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

Additional information about BROWN PHYSICIANS, INC.

Jurisdiction of Incorporation: Secretary of State Rhode Island

Incorporation Date: 2017-05-23

Company Identification Number: 1674012

Legal Registered Office Address: CAMERON & MITTLEMAN LLP
301 PROMENADE STREET
PROVIDENCE
United States of America (USA)
02908

More information about BROWN PHYSICIANS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE BROWN PHYSICIAN'S, INC. WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 ANGELA CALIENDO 2023-06-29
501 2021-01-01 ANGELA CALIENDO 2022-07-20
501 2020-01-01 ANGELA M. CALIENDO 2021-07-22
501 2019-01-01 ANGELA CALIENDO 2020-09-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	ANGELA CALIENDO	2023-06-29
501	2021-01-01	ANGELA CALIENDO	2022-07-20
501	2020-01-01	ANGELA M. CALIENDO	2021-07-22
501	2019-01-01	ANGELA CALIENDO	2020-09-16

Plan Statistics for THE BROWN PHYSICIAN'S, INC. WELFARE PLAN

401k plan membership statisitcs for THE BROWN PHYSICIAN'S, INC. WELFARE PLAN

Measure Date Value
2022: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,195
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,165
Number of retired or separated participants receiving benefits 2022-01-01 27
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 1,192
Number of employers contributing to the scheme 2022-01-01 0
2021: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,188
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,169
Number of retired or separated participants receiving benefits 2021-01-01 26
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 1,195
Number of employers contributing to the scheme 2021-01-01 0
2020: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 883
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,158
Number of retired or separated participants receiving benefits 2020-01-01 30
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 1,188
Number of employers contributing to the scheme 2020-01-01 0
2019: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 868
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 883
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 883
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2022: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,195
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,165
Number of retired or separated participants receiving benefits	2022-01-01	27
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	1,192
Number of employers contributing to the scheme	2022-01-01	0
2021: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,188
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,169
Number of retired or separated participants receiving benefits	2021-01-01	26
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	1,195
Number of employers contributing to the scheme	2021-01-01	0
2020: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	883
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,158
Number of retired or separated participants receiving benefits	2020-01-01	30
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	1,188
Number of employers contributing to the scheme	2020-01-01	0
2019: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	868
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	883
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	883
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for THE BROWN PHYSICIAN'S, INC. WELFARE PLAN

2022: THE BROWN PHYSICIAN'S, INC. WELFARE 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: THE BROWN PHYSICIAN'S, INC. WELFARE 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: THE BROWN PHYSICIAN'S, INC. WELFARE 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: THE BROWN PHYSICIAN'S, INC. WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

26391

Policy instance

Insurance contract or identification number	26391
Number of Individuals Covered	167
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,964
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $117,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,975
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )

Policy contract number

17938 ET AL

Policy instance

Insurance contract or identification number	17938 ET AL
Number of Individuals Covered	226
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,007
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM, LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $30,074
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	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

932404

Policy instance

Insurance contract or identification number	932404
Number of Individuals Covered	1109
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $117,935
Total amount of fees paid to insurance company	USD $39,145
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,597,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $109,383
Amount paid for insurance broker fees	39145
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53937

Policy instance

Insurance contract or identification number	53937
Number of Individuals Covered	1165
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,350
Total amount of fees paid to insurance company	USD $4,740
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $366,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,350
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30087104

Policy instance

Insurance contract or identification number	30087104
Number of Individuals Covered	752
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,617
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,617
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30087104

Policy instance

Insurance contract or identification number	30087104
Number of Individuals Covered	752
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,798
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,798
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53937

Policy instance

Insurance contract or identification number	53937
Number of Individuals Covered	1169
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $17,773
Total amount of fees paid to insurance company	USD $6,068
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $355,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,773
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

932404

Policy instance

Insurance contract or identification number	932404
Number of Individuals Covered	1112
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $70,456
Total amount of fees paid to insurance company	USD $32,427
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,587,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,456
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )

Policy contract number

17938 ET AL

Policy instance

Insurance contract or identification number	17938 ET AL
Number of Individuals Covered	222
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,155
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM, LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $31,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,155
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

26391

Policy instance

Insurance contract or identification number	26391
Number of Individuals Covered	228
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $16,647
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $62,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,394
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

26391

Policy instance

Insurance contract or identification number	26391
Number of Individuals Covered	175
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $36,397
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $67,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,067
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )

Policy contract number

17938-0001-001

Policy instance

Insurance contract or identification number	17938-0001-001
Number of Individuals Covered	148
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,430
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM, LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $19,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $847
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

932404

Policy instance

Insurance contract or identification number	932404
Number of Individuals Covered	1109
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $78,344
Total amount of fees paid to insurance company	USD $74,651
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,363,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,064
Amount paid for insurance broker fees	74651
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53937

Policy instance

Insurance contract or identification number	53937
Number of Individuals Covered	1158
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,178
Total amount of fees paid to insurance company	USD $198
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $363,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,294
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30087104

Policy instance

Insurance contract or identification number	30087104
Number of Individuals Covered	717
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $998
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $998
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

298696

Policy instance

Insurance contract or identification number	298696
Number of Individuals Covered	68
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $1,894
Total amount of fees paid to insurance company	USD $202
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $16,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,894
Amount paid for insurance broker fees	202
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RK032

Policy instance

Insurance contract or identification number	RK032
Number of Individuals Covered	18
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,070
Total amount of fees paid to insurance company	USD $22
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $30,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,184
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53937

Policy instance

Insurance contract or identification number	53937
Number of Individuals Covered	1111
Insurance policy start date	2019-10-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,368
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $873,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,368
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

20268035

Policy instance

Insurance contract or identification number	20268035
Number of Individuals Covered	12
Insurance policy start date	2019-10-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,191
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $283,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,191
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

1-017196-00

Policy instance

Insurance contract or identification number	1-017196-00
Number of Individuals Covered	202
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $1,897
Total amount of fees paid to insurance company	USD $1,177
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $42,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,897
Amount paid for insurance broker fees	1177
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD119927

Policy instance

Insurance contract or identification number	LTD119927
Number of Individuals Covered	320
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $1
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,710
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
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

10170965

Policy instance

Insurance contract or identification number	10170965
Number of Individuals Covered	258
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $16,501
Total amount of fees paid to insurance company	USD $4,715
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $110,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,799
Amount paid for insurance broker fees	4715
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

20257112

Policy instance

Insurance contract or identification number	20257112
Number of Individuals Covered	89
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $6,487
Total amount of fees paid to insurance company	USD $135
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $82,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,487
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEE

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

Policy contract number

900019

Policy instance

Insurance contract or identification number	900019
Number of Individuals Covered	114
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $15,450
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $129,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,058
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )

Policy contract number

17938-0001-001

Policy instance

Insurance contract or identification number	17938-0001-001
Number of Individuals Covered	80
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,056
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM, LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $10,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,056
Insurance broker organization code?	3

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

E01095

Policy instance

Insurance contract or identification number	E01095
Number of Individuals Covered	883
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,930
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $16,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $977
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

758E

Policy instance

Insurance contract or identification number	758E
Number of Individuals Covered	883
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,124
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $52,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,502
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6391

Policy instance

Insurance contract or identification number	6391
Number of Individuals Covered	883
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $621
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $7,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $339
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

94049

Policy instance

Insurance contract or identification number	94049
Number of Individuals Covered	89
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $6,487
Total amount of fees paid to insurance company	USD $135
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,487
Insurance broker organization code?	3
Amount paid for insurance broker fees	135
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEE

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

Policy contract number

152104

Policy instance

Insurance contract or identification number	152104
Number of Individuals Covered	414
Insurance policy start date	2019-01-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $27,906
Total amount of fees paid to insurance company	USD $23,301
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,906
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30087104

Policy instance

Insurance contract or identification number	30087104
Number of Individuals Covered	649
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,353
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,353
Insurance broker organization code?	3

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Company Name:	BROWN PHYSICIANS, INC.
Employer identification number (EIN):	821858635
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Secretary of State Rhode Island
Incorporation Date:	2017-05-23
Company Identification Number:	1674012
Legal Registered Office Address:	CAMERON & MITTLEMAN LLP 301 PROMENADE STREET PROVIDENCE United States of America (USA) 02908