| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 891016023 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | $0 | $13K | 9.50% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 891016023 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | $0 | $10K | 9.11% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 891016023 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFITS CONSULTANTS | 29122 RANCHO VIEJO ROAD, SUITE 106 SAN JUAN CAPISTRANO, CA 92675 | HM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 891016023 | ACE AMERICAN INSURANCE COMPANY | $206 | $0 | $206 | 19.96% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 454 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 511 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 965 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSMN, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 424 | $600K |
| Vision | HM LIFE INSURANCE COMPANY | 275 | $34K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 454 | $141K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 283 | $111K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 161 | $36K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 422 | $521K |
| Other(2 contracts, 2 carriers) | COMPSYCH | 454 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 454 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.