| 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 | — | $16K | $16K | 2.02% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET PO BOX 1116 HAMMONTON, NJ 08037 | RELIASTAR LIFE INSURANCE COMPANY | $66K | — | $66K | 16.94% |
| EMPYREAN INSURANCE SERVICES, INC.3 | 9009 WEST LOOP S STE. 600 HOUSTON, TX 77096 | RELIASTAR LIFE INSURANCE COMPANY | — | $16K | $16K | 4.00% |
| AON CONSULTING INC3 Filed as: AON CONSULTING INC. | 298 NETWORK PL CHICAGO, IL 60673 | RELIASTAR LIFE INSURANCE COMPANY | $11K | — | $11K | 2.83% |
| AMERICAN BENEFITS AND COMPENSATION3 | SYSTEMS INC. 101 PARK AVE., FL 14 NEW YORK, NY 101782103 | METROPOLITAN LIFE INSURANCE COMPANY | — | $7K | $7K | 2.04% |
| AMERICAN BENEFITS AND COMPENSATION3 | SYSTEMS INC. 101 PARK AVE., FL 14 NEW YORK, NY 101782103 | METROPOLITAN LIFE INSURANCE COMPANY | — | $12K | $12K | 17.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Float revenue; Other services; Claims processing; Non-monetary compensation; Direct payment from the plan; Participant communication; Named fiduciary; Contract Administrator Service code 12 | — | $379K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $100K |
| WEST HEALTH ADVOCATE NONE | Direct payment from the plan; Other services Service code 49 | 11808 MIRACLE DRIVE OMAHA, NE 68154 | $45K |
| METLIFE LEGAL PLANS EIN 34-1650967 NONE | Claims processing; Contract Administrator Service code 12 | — | $39K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 NONE | Contract Administrator; Claims processing Service code 12 | — | $32K |
| VISION SERVICE PLAN EIN 36-3560825 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $16K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Contract Administrator; Claims processing Service code 12 | — | $9K |
| HEALTH ADVOCATE SOLUTIONS, INC. EIN 23-3080019 NONE | Other services; Direct payment from the plan Service code 49 | — | $7K |
| PAYFLEX COBRA EIN 91-1774435 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $6K |
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 | 1,107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 303 | $1.5M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 4,243 | $789K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,422 | $69K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 468 | $361K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,137 | $365K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,243 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,243 | — |
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.