| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOTEK INSURANCE AGENCY INC3 Filed as: FOTEK INSURANCE AGENCY, INC. | 1512 HIGHWAY 138 WALL, NJ 07719 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $6K | $101K | $107K | 2.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $2K | $35K | $37K | 1.00% |
| EMERSON REID LLC3 Filed as: EMERSON REID AND COMPANY, INC. | 630 WEST GERMANTOWN PIKE, SUITE 215 PLYMOUTH MEETING, PA 19462 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 2.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.61% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $419 | $2K | 1.36% |
| TRAN VAN THANH3 | 1310 PROVIDENCE ROAD TOWSON, MD 21286 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $208 | — | $208 | 0.15% |
| FOTEK INSURANCE AGENCY INC3 Filed as: FOTEK INSURANCE AGENCY, INC. | 1512 HIGHWAY 138 WALL, NJ 07719 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 10.00% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 737 MAIN STREET, SUITE 200 BUFFALO, NY 14203 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 5.00% |
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 | 258 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 291 | $3.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 291 | $3.7M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $29K |
| Life insurance | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 406 | $143K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 406 | $143K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 291 | $3.7M |
| Other | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 406 | $143K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 406 | — |
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.