| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | $0 | $9K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $0 | $6K | 10.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $0 | $6K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $0 | $6K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 S. 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | EYEMED VISION CARE | $111 | $0 | $111 | 0.34% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.24% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 20.00% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, CORP. | 9700 ORMSBY STATION ROAD SUITE 200 LOUISVILLE, KY 40223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $152 | $0 | $152 | 0.77% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE RD SUITE 150 LAS VEGAS, NV 891290209 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 20.00% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, CORP. | 9700 ORMSBY STATION ROAD SUITE200 LOUISVILLE, KY 40223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $107 | $0 | $107 | 0.78% |
| CUSTOM BENEFIT CONSULTANTS INC.3 | 3295 N FORT APACHE RD STE 150 LAS VEGAS, NV 89129 | METROPOLITAN GENERAL INSURANCE COMPANY | $1K | $0 | $1K | 10.02% |
| CUSTOM BENEFIT CONSULTANTS INC.3 | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 20.00% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, CORP. | 9700 ORMSBY STATION ROAD SUITE 200 LOUISVILLE, KY 40223 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $75 | $0 | $75 | 0.73% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 3295 N FORT APACHE ROAD SUITE 150 LAS VEGAS, NV 89129 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.00% |
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 | 500 | 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) | 500 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 92 | $565K |
| Dental | HAWAII DENTAL SERVICE | 72 | $30K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 496 | $585K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 558 | $121K |
| Short-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 107 | $58K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 95 | $42K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 67 | $552K |
| Other(7 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 558 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 558 | — |
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.