| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 62939 VIRGINIA BEACH, VA 234662939 | METROPOLITAN LIFE INSURANCE COMPANY | $10 | $60 | $70 | 0.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 8331 NORMAN CENTER DRIVE SUITE 500 BLOOMINGTON, MN 554374501 | RELIASTAR LIFE INSURANCE COMPANY | $2K | — | $2K | 2.30% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST INC | PO BOX 203383 DALLAS, TX 753203380 | RELIASTAR LIFE INSURANCE COMPANY | $2K | — | $2K | 2.04% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $612 | $261 | $873 | 5.38% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1750 H STREET NW STE 200 WASHINGTON, DC 20006 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $206 | — | $206 | 1.27% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | FIRST UNUM LIFE INSURANCE COMPANY | $115 | — | $115 | 3.76% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 1750 H STREET NW STE 200 WASHINGTON, DC 20006 | FIRST UNUM LIFE INSURANCE COMPANY | $39 | — | $39 | 1.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $236K |
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 | 519 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 519 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,214 | $548K |
| Vision | NATIONAL VISION ADMINISTRATORS LLC | 761 | $51K |
| Life insurance(3 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 488 | $117K |
| Other(3 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 488 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,214 | — |
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.