| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TOTALIS BENEFITS3 Filed as: TOTALIS BENEFITS, INC. | 8777 N GAINEY CENTER DRIVE, STE 260 SCOTTSDALE, AZ 85258 | HARTFORD LIFE AND ACCIDENT | — | $64K | $64K | 5.99% |
| ENROLLEASE3 Filed as: FIRST PERSON INC | 8900 KEYSTONE CROSSING, STE 900 INDIANAPOLIS, IN 46240 | HARTFORD LIFE AND ACCIDENT | $28 | — | $28 | 0.00% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62819 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $0 | $0 | $0 | 0.00% |
| WELLS FARGO INSURANCE SERVICES7 Filed as: WELLS FARGO INSURANCE SERVICES USA | 6100 FAIRVIEW ROAD, STE 1400 CHARLOTTE, NC 28210 | JOHN HANCOCK LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62819 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | — |
| GOODRUM, PHILLIP, PORTER5 | 6230 FAIRVIEW RD, STE 210 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | — |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES CORP | 200 SUMMIT LAKE DR STE 350 VALHALLA, NY 10595 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | — | $0 | — |
| USI INSURANCE SERVICES LLC3 | PO BOX 62819 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | — | $13K | — |
| GOODRUM, PHILLIP, PORTER5 | 6230 FAIRVIEW RD,STE 210 CHARLOTTE, NC 28210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $350 | — | $350 | — |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES CORP | 200 SUMMIT LAKE DR STE 350 VALHALLA, NY 10595 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CARE TEAM HEALTH, LLC EIN 81-3561997 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $903K |
| UMR, INC. EIN 39-1995276 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $599K |
| SOUTHERN SCRIPTS, LLC EIN 47-4999303 CONTRACT ADMINISTRATOR | Other fees Service code 99 | — | $407K |
| FLORES AND ASSOCIATES EIN 56-1542307 PPO MANAGER | Contract Administrator Service code 13 | — | $14K |
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 | 1,038 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,040 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,041 | $1.1M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,041 | $1.1M |
| Stop-loss / reinsurancereinsurance | SIRIUSPOINT AMERICA INSURANCE COMPANY | 1,044 | $861K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 1,041 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,044 | — |
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.