| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1301 EAST NINTH STREET, SUITE 38 CLEVELAND, OH 44114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $4K | $4K | 0.74% |
| USI INSURANCE SERVICES LLC3 | 1 SEAGATE, SUITE 1800 TOLEDO, OH 43604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 0.70% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $171 | $2K | 0.36% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $128 | $2K | 0.36% |
| USI INSURANCE SERVICES LLC3 | 1 SEAGATE, SUITE 1800 TOLEDO, OH 43604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $6 | $6K | 12.76% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $225 | $3K | 5.75% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $169 | $3K | 5.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 1001 LAKESIDE AVENUE, SUITE 1500 CLEVELAND, OH 44114 | ACE AMERICAN INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
No Schedule C service providers reported on this filing.
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 | 873 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 122 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,010 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 914 | $887K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 914 | $599K |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 914 | $904K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 914 | — |
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.