| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SERVICES | PO BOX 28 DUBUQUE, IA 52004 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 0.70% |
| USI INSURANCE SERVICES LLC3 | ENTERPRISE LICENSING CENTER 601 UNION ST SUITE 1000 SEATTLE, WA 98101 | HARTFORD LIFE AND ACCIDENT | — | -$21 | -$21 | -0.01% |
| SMITH, THOMAS, CHRISTOPHER3 | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $743 | $9K | 8.74% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $442 | $6K | 5.48% |
| SMITH, THOMAS, CHRISTOPHER3 | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $287 | $4K | 9.96% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN STREET DUBUQUE, IA 52001 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $86 | $2K | 4.49% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC | AN AON COMPANY 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $479 | $219 | $698 | 1.74% |
| USI INSURANCE SERVICES LLC3 | STE 400 8000 NORMAN CENTER DR BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $205 | — | $205 | 0.51% |
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 | 459 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 462 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,613 | $356K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 371 | $105K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 1,613 | $502K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,613 | — |
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."
No prospect flags tripped on this filing.