| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACS BENEFIT SERVICES LLC5 Filed as: ACS BENEFIT SERVICES, LLC | 5660 UNIVERSITY PARKWAY 5TH FLOOR WINSTON SALEM, NC 27105 | HCC LIFE INSURANCE COMPANY | $13K | — | $13K | 2.00% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 12748 ROANOKE, VA 240282748 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $34 | $12K | 3.43% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN | 250 PEHLE AVE STE 400 SADDLE BROOK, NJ 076635826 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $4K | $4K | 1.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACS BENEFIT SERVICES, LLC EIN 56-1472467 NONE | Contract Administrator; Claims processing Service code 12 | 5660 UNIVERSITY PARKWAY 5TH FLOOR WINSTON SALEM, NC 27105 | $144K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator Service code 13 | P.O. BOX 645014 CINCINNATI, OH 452645014 | $60K |
| SELF-FUNDING ACTUARIAL SERVICES EIN 56-1472476 NONE | Actuarial Service code 11 | P.O. BOX 11166 WINSTON SALEM, NC 27106 | $5K |
| INOVA EMPLOYEE ASSISTANCE EIN 54-0620889 NONE | Contract Administrator Service code 13 | 3949 PENDER DRIVE SUITE 310 FAIRFAX, VA 22030 | $4K |
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 | 396 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 399 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 701 | $349K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 701 | $349K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 399 | $665K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 701 | $349K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 701 | — |
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.