| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT ROAD, SUITE 200 BERWYN, PA 19312 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | -$58 | $488 | $430 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $179 | — | $179 | 0.02% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS LLC | 700 KINDERKAMACK ROAD, SUITE 205 ORADELL, NJ 07675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | $236 | $9K | 7.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LTD | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $221 | $4K | 3.00% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PK STE 200 BERWYN, PA 19312 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $61 | $2K | 1.59% |
| EMERSON REID LLC3 Filed as: EMERSON REID, LLC | 1787 SENTRY PARKWAY WEST, VEVA 16 SUITE 320 BLUE BELL, PA 19422 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.04% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $678 | — | $678 | 0.56% |
| TRAN, THANH, VAN3 | 5409 OLD STAGE ROAD RALEIGH, NC 27603 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 0.06% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT ROAD SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $1K | $13K | 16.99% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT ROAD, SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $1K | $10K | 17.15% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS CO | 899 CASSATT ROAD, SUITE 200 BERWYN, PA 19312 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 10.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LTD | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | METROPOLITAN LIFE INSURANCE COMPANY | $125 | $41 | $166 | 0.37% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS LLC | 700 KINDERKAMACK ROAD STE 205 ORADELL, NJ 07675 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $22 | $1K | 25.47% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PARK STE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $747 | $27 | $774 | 13.99% |
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 | 397 | 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) | 397 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 467 | $974K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 467 | $847K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 467 | $847K |
| Life insurance(3 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 432 | $242K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 432 | $121K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 81 | $58K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 467 | $847K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 397 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 467 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.