| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMERICAN BENEFITS AND COMPENSATION3 | SYSTEMS INC. 101 PARK AVE., FL 14 NEW YORK, NY 101782103 | METROPOLITAN LIFE INSURANCE COMPANY | — | $15K | $15K | 2.05% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 606731298 | TOKIO MARINE HCC | — | $9K | $9K | 2.00% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET PO BOX 1116 HAMMONTON, NJ 08037 | RELIASTAR LIFE INSURANCE COMPANY | $47K | — | $47K | 16.07% |
| EMPYREAN INSURANCE SERVICES, INC.3 | 2103 CITYWEST BLVD., STE. 200 HOUSTON, TX 77042 | RELIASTAR LIFE INSURANCE COMPANY | — | $16K | $16K | 5.48% |
| AON CONSULTING INC3 Filed as: AON CONSULTING INC. | 29840 NETWORK PL CHICAGO, IL 60673 | RELIASTAR LIFE INSURANCE COMPANY | $12K | — | $12K | 4.07% |
| AMERICAN BENEFITS AND COMPENSATION3 | SYSTEMS INC. 101 PARK AVE., FL 14 NEW YORK, NY 101782103 | METROPOLITAN LIFE INSURANCE COMPANY | — | $5K | $5K | 1.89% |
| AMERICAN BENEFITS AND COMPENSATION3 | SYSTEMS INC. 101 PARK AVE., FL 14 NEW YORK, NY 101782103 | METROPOLITAN LIFE INSURANCE COMPANY | — | $12K | $12K | 12.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Named fiduciary; Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Float revenue; Participant communication Service code 12 | — | $272K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $55K |
| METLIFE LEGAL PLANS EIN 34-1650967 NONE | Claims processing; Contract Administrator Service code 12 | — | $37K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 NONE | Contract Administrator; Claims processing Service code 12 | — | $33K |
| WEST HEALTH ADVOCATE NONE | Direct payment from the plan; Other services Service code 49 | 11808 MIRACLE DRIVE OMAHA, NE 68154 | $21K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Claims processing; Contract Administrator Service code 12 | — | $9K |
| VISION SERVICE PLAN EIN 36-3560825 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $9K |
| PAYFLEX COBRA EIN 91-1774435 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $5K |
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 | 1,120 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 300 | $1.7M |
| Vision | VISION SERVICE PLAN | 1,079 | $102K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 4,155 | $738K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,251 | $98K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 490 | $274K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | TOKIO MARINE HCC | 870 | $431K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,155 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,155 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.