| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 218060 HOUSTON, TX 77218 | LINCOLN LIFE AND ANNUITY COMPANY OF NEW YORK | — | $25K | $25K | 1.72% |
| ANCO INS. SVC. OF BRYAN COLLEGE STA3 Filed as: ANCO INSURANCE SERVICES CORPORATION | 840 GESSNER, SUITE 600 HOUSTON, TX 77024 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | — | $17K | 1.82% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 840 GESSNER, SUITE 600 HOUSTON, TX 77024 | VISION SERVICE PLAN | $7K | — | $7K | 1.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $1K | — | $1K | 0.24% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 840 GESSNER, SUITE 600 HOUSTON, TX 77024 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $24K | $2K | $26K | 14.62% |
| BERTHOLON ROWLAND INC3 Filed as: BERTHOLON ROWLAND, INC. | 1 INTERNATIONAL PLAZA, SUITE 400 PHILADELPHIA, PA 19113 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $276 | $3K | 1.39% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $3K | $14K | 14.73% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $576 | — | $576 | 0.61% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 879 12TH STREET HAMMONTON, NJ 08037 | CONTINENTAL AMERICAN INSURANCE COMPANY | $13K | — | $13K | 19.28% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | FIRST UNUM LIFE INSURANCE COMPANY | $120 | — | $120 | 5.02% |
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 | 3,456 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,456 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 9,981 | $508K |
| Dental | DELTA DENTAL OF NEW YORK, INC. | 946 | $161K |
| Vision | VISION SERVICE PLAN | 2,861 | $521K |
| Life insurance(2 contracts, 2 carriers) | LINCOLN LIFE AND ANNUITY COMPANY OF NEW YORK | 4,280 | $1.6M |
| Short-term disability(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,456 | $1.0M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,456 | $916K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 94 | $433K |
| Other(8 contracts, 8 carriers) | LINCOLN LIFE AND ANNUITY COMPANY OF NEW YORK | 4,451 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,981 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.