| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 8331 NORMAN CENTER DR STE 500 MINNEAPOLIS, MN 55437 | HARTFORD LIFE AND ACCIDENT | — | -$3 | -$3 | -0.00% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN ST DUBUQUE, IA 52001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $317 | $4K | 4.35% |
| SMITH, THOMAS, CHRISTOPHER3 | PO BOX 40386 798 BERRY RD NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.57% |
| SMITH, THOMAS, CHRISTOPHER3 | PO BOX 40386 798 BERRY RD NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $769 | — | $769 | 2.29% |
| 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 | $379 | $194 | $573 | 1.70% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN STREET DUBUQUE, IA 52001 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $366 | $2 | $368 | 1.09% |
| USI INSURANCE SERVICES LLC3 | STE 400 8000 NORMAN CENTER DR BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $162 | — | $162 | 0.48% |
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 | 406 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 406 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,452 | $309K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 310 | $101K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 1,452 | $444K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,452 | — |
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.