| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP LLC | NCB-88 PO BOX 1414 MINNEAPOLIS, MN 55480 | AETNA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 5.22% |
| TOMPKINS INSURANCE AGENCIES3 Filed as: TOMPKINS INSURANCE AGENCIES INC | 90 MAIN STREET BATAVIA, NY 14020 | AETNA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.59% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | DELTA DENTAL OF PENNSYLVANIA | $981 | $0 | $981 | 1.84% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP, INC. | 80 S. 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $464 | $0 | $464 | 4.39% |
| TOMPKINS INSURANCE AGENCIES3 | 90 MAIN STREET BATAVIA, NY 14020 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $171 | $0 | $171 | 1.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 ADMIN | Claims processing Service code 12 | — | $90K |
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 | 382 | 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) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 246 | $53K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 138 | $11K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 382 | $137K |
| Short-term disability | AETNA LIFE INSURANCE COMPANY | 382 | $137K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 382 | $137K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE | 201 | $150K |
| Other | AETNA LIFE INSURANCE COMPANY | 382 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 382 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.