| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $13K | $13K | 1.96% |
| BARRETT BENEFITS GROUP3 Filed as: BARRETT BENEFITS GROUP, INC. | 593 BROADWAY BEDFORD, OH 44146 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $13K | $13K | 1.96% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $9K | $14K | 3.29% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, NJ 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $162 | $3K | 4.05% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $321 | $0 | $321 | 0.43% |
| HAYS COMPANIES, INC.3 Filed as: JAMES C. HAYS | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 0.04% |
| BARRETT BENEFITS GROUP3 | 3628 WALNUT HILLS ROAD, SUITE 200 CLEVELAND, OH 44122 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $362 | $0 | $362 | 10.16% |
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 | 1,131 | 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) | 1,133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 136 | $645K |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 216 | $75K |
| Vision(2 contracts, 2 carriers) | NGL | 812 | $45K |
| Life insurance(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,131 | $503K |
| Short-term disability(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,131 | $503K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,131 | $426K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 136 | $645K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,131 | $426K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,131 | — |
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.