| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT CONSULTANTS INC.4 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 3295 N FORT APACHE RD, STE 150 LAS VEGAS, NV 89129 | EVEREST REINSURANCE COMPANY | — | $47K | $47K | 11.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERICAN BENEFIT CORPORATION EIN 55-0672859 THIRD PARTY ADMINISTRATOR | Direct payment from the plan; Consulting (general); Contract Administrator; Claims processing; Recordkeeping fees Service code 12 | 9200 US ROUTE 60 ONA, WV 25545 | $193K |
| DENISE MANN EIN 23-7404076 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | P.O. BOX 638 NORWALK, OH 44857 | $58K |
| ALLOTTA, FARLEY & CO., LPA EIN 34-1316963 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 3240 LEVIS COMMONS BLVD. PERRYSBURG, OH 43551 | $52K |
| SEGAL CONSULTING EIN 13-1975125 CONSULTANT, ACTUARY | Consulting (general); Actuarial; Direct payment from the plan Service code 11 | 1111 SUPERIOR AVE 2340 CHICAGO, IL 60606 | $49K |
| PAYNE NICKLES & CO. EIN 34-1664586 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | 257 BENEDICT AVE, BLDG D NORWALK, OH 44857 | $34K |
| PNC BANK EIN 22-1146430 INVESTMENT MANAGER | Custodial (other than securities); Investment management; Soft dollars commissions; Custodial (securities) Service code 18 | 1900 E 9TH STREET CLEVELAND, OH 44114 | $26K |
| COSTCO HEALTH SOLUTIONS, INC. EIN 81-2865195 ADMINISTRATIVE SERVICES | Claims processing; Direct payment from the plan; Recordkeeping fees Service code 12 | 999 LAKE DRIVE ISSAQUAH, WA 98027 | $25K |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 109 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 649 | $419K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 649 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.