| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYES COMPANIES INC | 80 SOUTH ST STE 700 MINNEAPOLIS, MN 55402 | AMERICA UNITED LIFE INSURANCE COMPANY | — | $5K | $5K | 3.68% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN INSURANCE SERVICES | 3001 EMRICK BLVD. STE 120 BETHLEHEM, PA 18020 | AMERICA UNITED LIFE INSURANCE COMPANY | — | $2K | $2K | 1.31% |
| HAYS COMPANIES, INC.3 Filed as: HAYES COMPANIES INC | 80 SOUTH ST STE 700 MINNEAPOLIS, MN 55402 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | — | $418 | $418 | 2.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES INC EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator; Insurance agents and brokers Service code 13 | — | $253K |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Named fiduciary; Other services; Contract Administrator; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; Claims processing Service code 12 | — | $23K |
| PROACT PHARMACY SERVICES INC. EIN 83-2100850 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $11K |
| CAREBRIDGE CORPORATION EIN 23-2614764 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $7K |
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 | 782 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 782 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 189 | $20K |
| Dental(6 contracts, 6 carriers) | CIGNA DENTAL HEALTH OF NEW JERSEY, INC | 64 | $15K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 468 | $39K |
| Life insurance | AMERICA UNITED LIFE INSURANCE COMPANY | 547 | $128K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 0 | $407K |
| Other | AMERICA UNITED LIFE INSURANCE COMPANY | 547 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 547 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.