| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMERICAN BENEFITS & COMP SYSTEMS3 Filed as: AMERICAN BENEFITS & COMP | 101 PARK AVE 14TH FLOOR NEW YORK, NY 10178 | HARTFORD LIFE AND ACCIDENT | — | $131K | $131K | 2.50% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE INC | PO BOX 1388 SUITE 33 BANGOR, ME 04402 | HARTFORD LIFE AND ACCIDENT | — | $11K | $11K | 0.21% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | PO BOX 8299 PASADENA, CA 91109 | VISION SERVICE PLAN | $5 | — | $5 | 0.00% |
| AMERICAN BENEFITS & COMP SYSTEMS3 Filed as: AMERICAN BENEFITS & COMP | 101 PARK AVE 14TH FLOOR NEW YORK, NY 10178 | HARTFORD LIFE AND ACCIDENT | $22K | $2K | $24K | 12.22% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE-CONNECTICUT | 2 CORPORATE DRIVE SUITE 335 SHELTON, CT 06484 | HARTFORD LIFE AND ACCIDENT | $7K | $119 | $7K | 3.68% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE-SHELTON | 2 CORPORATE DR STE 335 SHELTON, CT 06484 | FEDERAL INSURANCE COMPANY | $20K | — | $20K | 15.00% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE-CONNECTICUT | PO BOX 1388 BANGOR, ME 04402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 3.77% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC | 897 12TH ST HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $313 | — | $313 | 0.39% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | PO BOX 120670 SAN DIEGO, CA 92101 | HUMANA HEALTH PLANS OF PUERTO RICO INC. | $2K | — | $2K | 7.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 ADMIN SERVICES AGREEMENT | Participant communication; Insurance mortality and expense charge; Named fiduciary; Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Other services Service code 12 | — | $4.4M |
| CVS CAREMARK EIN 05-0340626 ADMIN SERVICES AGREEMENT | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $23K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $16K |
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 | 5,993 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 55 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 82 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA HEALTH PLANS OF PUERTO RICO INC. | 9 | $23K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF NJ, INC. | 11,137 | $4.7M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 4,797 | $579K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 8,567 | $5.2M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 8,567 | $5.2M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 8,567 | $5.2M |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 8,567 | $5.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,137 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.