| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $56K | $56K | 6.17% |
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | KAISER FOUNDATION HEALTH PLAN, INC. | $25K | $0 | $25K | 2.86% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | $0 | $7K | 0.81% |
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | AETNA LIFE INSURANCE COMPANY | $0 | $201 | $201 | 0.03% |
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 5.09% |
| LONG TERM CARE SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 4.66% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $924 | $65 | $989 | 1.80% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $924 | $65 | $989 | 1.80% |
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 11.77% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $167 | $2K | 6.06% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $167 | $2K | 6.06% |
| THOMAS CHRISTOPHER SMITH3 | 798 BERRY ROAD NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $339 | $0 | $339 | 0.96% |
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $1K | $778 | $2K | 7.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 5001 LOUISE DRIVE, SUITE 301 MECHANICSBURG, PA 17055 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $106 | $0 | $106 | 0.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $0 | $37 | $37 | 0.13% |
| CORPORATE SYNERGIES GROUP LLC3 Filed as: CORPORATE SYNERGIES GROUP, INC. | 2 AQUARIUM DRIVE, SUITE 200 CAMDEN, NJ 08103 | FIRST UNUM LIFE INSURANCE COMPANY | $45 | $0 | $45 | 4.06% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $22 | $1 | $23 | 2.07% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | FIRST UNUM LIFE INSURANCE COMPANY | $22 | $1 | $23 | 2.07% |
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 | 1,764 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 85 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,849 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 145 | $876K |
| Dental | AETNA LIFE INSURANCE COMPANY | 2,809 | $731K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 2,572 | $109K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,916 | $903K |
| Short-term disability(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,916 | $939K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,916 | $903K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 145 | $876K |
| Other(6 contracts, 6 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,916 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,809 | — |
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."
No prospect flags tripped on this filing.