| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ST JOHN, GORDON3 | PENTRA INC 795 E LANCASTER AVE STE 210 VILLANOVA, PA 19085 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $228K | $0 | $228K | 2.76% |
| PENTRA LLC3 Filed as: PENTRA INC | 795 E. LANCASTER AVE. SUITE 210 VILLANOVA, PA 190851500 | AETNA LIFE INSURANCE CO. | $48K | $8K | $56K | 8.43% |
| NICHOLAS H. LAMOTTE3 Filed as: NICHOLAS H LA MOTTE | TWO VILLANOVA CENTER 795 E LANCASTER AVE STE 210 VILLANOVA, PA 190851525 | MUTUAL OF OMAHA INSURANCE COMPANY | $10K | $0 | $10K | 10.00% |
| NICHOLAS H. LAMOTTE3 Filed as: NICHOLAS H LA MOTTE | TWO VILLANOVA CENTER 795 E LANCASTER AVE STE 210 VILLANOVA, PA 190851525 | COMPANION LIFE INSURANCE COMPANY | $5K | $0 | $5K | 10.00% |
| NICHOLAS H. LAMOTTE3 Filed as: NICHOLAS H. LA MOTTE | 795 E LANCASTER AVE STE 210 VILLANOVA, PA 190851525 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.05% |
| NICHOLAS H. LAMOTTE3 Filed as: NICHOLAS H LA MOTTE | TWO VILLANOVA CENTER 795 E LANCASTER AVE STE 210 VILLANOVA, PA 190851525 | COMPANION LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| NICHOLAS H. LAMOTTE3 Filed as: NICHOLAS LAMOTTE | INTEGRATED BENEFIT SERVICES INC 795 E LANCASTER AVE STE 200 VILLANOVA, PA 19085 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $0 | $2K | 15.81% |
| THE MAXON COMPANY5 | 76 NORTH BROADWAY IRVINGTON, NY 10533 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $713 | $713 | 5.73% |
| NICHOLAS H. LAMOTTE3 Filed as: NICHOLAS H LA MOTTE | TWO VILLANOVA CENTER 795 E LANCASTER AVE STE 210 VILLANOVA, PA 190851525 | MUTUAL OF OMAHA INSURANCE COMPANY | $352 | $0 | $352 | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WAGEWORKS EIN 94-3351864 NONE | Contract Administrator; Claims processing Service code 12 | — | $36K |
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 | 475 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 491 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,213 | $8.3M |
| Dental | AETNA LIFE INSURANCE CO. | 1,144 | $666K |
| Vision | VISION SERVICE PLAN | 480 | $41K |
| Life insurance(2 contracts) | COMPANION LIFE INSURANCE COMPANY | 443 | $73K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 464 | $12K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 263 | $105K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,213 | $8.3M |
| Other(3 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 443 | $159K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,213 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.