| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $127K | $0 | $127K | 3.56% |
| PREMIER WORKSITE SOLUTIONS INC Filed as: PREMIER WORKSITE SOLUTIONS LLC | 700 KINDERKAMACK ROAD SUITE 205 ORADELL, NJ 07675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $0 | $10K | 8.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $0 | $7K | 6.00% |
| EMERSON REID LLC3 | 1787 SENTRY PARKWAY, SUITE 320 BLUE BELL, PA 19422 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 1.36% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $797 | $336 | $1K | 0.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 EAST JACKSON BOULEVARD SUITE 14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $573 | $573 | 0.47% |
| VAN THANH TRAN3 | 5409 OLD STAGE ROAD RALEIGH, NC 27603 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $103 | $0 | $103 | 0.08% |
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 | 271 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 271 | $3.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 271 | $3.6M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 271 | $3.6M |
| Life insurance | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 441 | $121K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 441 | $121K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 271 | $3.6M |
| Other | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 441 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 441 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.