| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REUBEN WARNER ASSOCIATES, INC.3 | 300 CONNELL DRIVE, SUITE 100 BERKELEY HEIGHTS, NJ 07922 | SHELTERPOINT LIFE INSURANCE COMPANY | $5K | — | $5K | 5.00% |
| EMERSON REID LLC3 | 350 5TH AVE, STE 3700 NEW YORK, NY 10118 | UNITED OF OMAHA LIFE INS. CO. | $0 | $4K | $4K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INS. CO. | $0 | $3K | $3K | 4.04% |
| USI INSURANCE SERVICES LLC3 | 725 RXR PLAZA, EAST TOWER UNIONDALE, NY 11556 | SHELTERPOINT LIFE INSURANCE COMPANY | $4K | $0 | $4K | 7.84% |
| EMERSON REID LLC3 | 350 5TH AVE, STE 3700 NEW YORK, NY 10118 | UNITED OF OMAHA LIFE INS. CO. | $0 | $3K | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INS. CO. | $0 | $2K | $2K | 3.97% |
| EMERSON REID LLC3 | 350 5TH AVE, STE 3700 NEW YORK, NY 10118 | UNITED OF OMAHA LIFE INS. CO. | $0 | $2K | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INS. CO. | $0 | $2K | $2K | 4.18% |
| EMERSON REID LLC3 | 350 5TH AVE, STE 3700 NEW YORK, NY 10118 | UNITED OF OMAHA LIFE INS. CO. | $0 | $1K | $1K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INS. CO. | $0 | $1K | $1K | 3.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 ADMINISTRATOR | Contract Administrator Service code 13 | — | $171K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $17K |
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 | 376 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 376 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE CO. | 134 | $24K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INS. CO. | 376 | $110K |
| Short-term disability(3 contracts, 2 carriers) | SHELTERPOINT LIFE INSURANCE COMPANY | 640 | $188K |
| Long-term disability | UNITED OF OMAHA LIFE INS. CO. | 376 | $51K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE CO AND AFFILIATES | 482 | $342K |
| Other(2 contracts, 2 carriers) | SHELTERPOINT LIFE INSURANCE COMPANY | 376 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 640 | — |
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.