| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WH ADMINISTATORS INC3 | 2 BETHESDA METRO CTR STE 450 BETHESDA, MD 208146319 | RELIASTAR LIFE INSURANCE COMPANY | $179K | — | $179K | 20.00% |
| CORPORATE ONE BENEFITS3 Filed as: CORPORATE ONE BENEFITS AGENCY | PO BOX 906 FOSTORIA, OH 44830 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.88% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $377 | $3K | 3.79% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $733 | $4K | 20.63% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 61.75% |
| DWIGHT L PIERCE5 Filed as: DWIGHT PIERCE BENEFITS TECHNOLOGIES | DIV 10 1200 E TAFT AVE SAPULPA, OK 74066 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $49 | — | $49 | 0.28% |
| CORPORATE ONE BENEFITS3 Filed as: CORPORATE ONE BENEFITS AGENCY INC | PO BOX FOSTORIA, OH 44830 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16 | — | $16 | 0.09% |
| COB INC3 | PO BOX 15023 PIKESVILLE, MD 21282 | TRANSAMERICA LIFE INSURANCE COMPANY | $192 | — | $192 | 18.86% |
| AFFINITY GROUP UNDERWRITERS3 Filed as: AFFINITY GROUP UNDERWRITERS INC | 4510 COX RD STE 111 GLEN ALLEN, VA 23060 | TRANSAMERICA LIFE INSURANCE COMPANY | $103 | — | $103 | 10.12% |
| COB INC3 | PO BOX 15023 PIKESVILLE, MD 212825023 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $103 | — | $103 | 21.87% |
| ROBERT D SACKS EMPLOYEE SECURITY5 | 10400 LITTLE PATUXENT PKWY STE 260 COLUMBIA, MD 21044 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $34 | $34 | 7.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WH ADMINISTRATORS INC EIN 46-3116152 ADMINISTRATIVE AGREEMENT | Named fiduciary; Plan Administrator; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | 2 BETHESDA METRO CTR 4TH FL BETHESDA, MD 208146319 | $893K |
| MEDICAL BENEDFITS ADMINISTRATORS EIN 31-1249371 CONTRACT | Claims processing Service code 12 | 1975 TAMARACK RD PO BOX 1009 NEWARK, OH 430581009 | $48K |
| CUSTOM DESIGN BENEFITS EIN 81-0798821 CONTRACT | Claims processing Service code 12 | 5589 CHEVIOT RD CINCINNATI, OH 45247 | $46K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ADMINISTRATIVE AGREEMENT | Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Float revenue; Direct payment from the plan; Contract Administrator; Other services Service code 12 | PO BOX 644546 PITTSBURGH, PA 152644546 | $19K |
| GLOBAL CARE (ZELLIS) EIN 31-1407689 CONTRACT | Other fees Service code 99 | 6875 SHILOH ROAD EAST ALPHARETTA, GA 30005 | $9K |
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 | 359 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 360 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 748 | $54K |
| Life insurance(4 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 1,092 | $999K |
| Short-term disability(3 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 1,092 | $912K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 521 | $85K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 1,092 | $960K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,092 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.