| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TFFNY BENEFITS | 899 CASSATT ROAD SUITE 200 C/O WILLIAM O DAGGETT JR BERWYN, PA 19312 | HM LIFE INSURANCE COMPANY | $153K | — | $153K | 15.00% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER-TIFFANY BENEFITS COMPANY | 400 BERWYN PARK SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $19K | $20K | $39K | 4.93% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS COM3PANY | 899 CASSATT ROAD 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | METROPOLITAN LIFE INSURANCE COMPANY | $33K | $9K | $42K | 5.83% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT ROAD SUITE 200 BERWYN, PA 19312 | VISION SERVICE PLAN | $3K | — | $3K | 2.21% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER-TIFFANY BENEFITS COMPANY | 400 BERWYN PARK SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | $4K | $26K | 18.59% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER-TIFFANY BENEFITS COMPANY | 400 BERWYN PARK SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17K | $1K | $19K | 35.87% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $1K | $10K | 18.88% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE ROAD SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $48 | $9K | 16.71% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER-TIFFANY BENEFITS COMPANY | 400 BERWYN PARK SUITE 200 BERWYN, PA 19312 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $379 | $8K | 47.32% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $338 | $4K | 24.58% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE ROAD SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $27 | $4K | 22.65% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER-TIFFANY BENEFITS COMPANY | 400 BERWYN PARK SUITE 200 BERWYN, PA 19312 | FIRST UNUM LIFE INSURANCE COMPANY | $22 | — | $22 | 45.83% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE ROAD SUITE 206 ROSWELL, GA 30075 | FIRST UNUM LIFE INSURANCE COMPANY | $11 | — | $11 | 22.92% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $11 | — | $11 | 22.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INDEPENDENCE BLUE CROSS EIN 23-0370270 CARRIER | Insurance services Service code 23 | — | $302K |
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 | 1,112 | 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) | 1,112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 2,143 | $720K |
| Vision | VISION SERVICE PLAN | 1,017 | $148K |
| Life insurance(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,026 | $956K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,026 | $798K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,026 | $798K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 952 | $1.0M |
| Other(5 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,026 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,143 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.