| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE INDEMNITY GROUP LLC3 Filed as: INDEMNITY GROUP LLC | 3628 WALNUT HILLS AVE STE 200 ORANGE VILLAGE, OH 441224484 | MEDICAL MUTUAL | $19K | $12K | $31K | 3.08% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP OF WI LLC | 1200 NORTH MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $8K | $8K | 2.14% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFITS GROUP WISCONSIN | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 5.02% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $711 | $522 | $1K | 1.21% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $611 | $611 | 0.60% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $573 | — | $573 | 0.56% |
| HAYS COMPANIES, INC.3 Filed as: JAMES C HAYS | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 0.09% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $688 | $6K | 17.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP OF WISCONSIN | PO BOX 1414 MINNEAPOLIS, MN 55480 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 13.14% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $476 | $476 | 2.00% |
| BARRET BENEFITS GROUP INC.3 Filed as: BARRET BENEFITS GROUP INC | 3628 WALNUT HILLS AVE SUITE 200 BEACHWOOD, OH 441224484 | VISION SERVICE PLAN | $541 | — | $541 | 9.31% |
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 | 1,225 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICAL MUTUAL | 133 | $1.0M |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 323 | $107K |
| Vision(2 contracts, 2 carriers) | NATIONAL VISION ADMINISTRATORS LLC | 495 | $45K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,230 | $461K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,230 | $461K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,230 | $383K |
| Prescription drug | MEDICAL MUTUAL | 133 | $1.0M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,230 | $394K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,230 | — |
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."
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.