| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DR., STE 100 INDIANAPOLIS, IN 46240 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $270K | — | $270K | 11.99% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DR., STE 100 INDIANAPOLIS, IN 46240 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $68K | — | $68K | 3.01% |
| HARVARD PRINTING GROUP5 | C/O NEWTEK BUSINESS CREDIT P. O. BOX 380 WEST HEMPSTEAD, NY 11552 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $785 | $785 | 0.03% |
| ASSUREDPARTNERS3 Filed as: THE HDH GROUP INC. | 210 6TH AVE., 30TH FLOOR PITTSBURGH, PA 15222 | HIGHMARK INC. | $49K | — | $49K | 2.77% |
| MCKELVEY, PHILIP, NEILL3 | 600 W LOVELAND AVE., SUITE 5A LOVELAND, OH 45140 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 2.80% |
| M J INSURANCE INC.3 Filed as: M-J INSURANCE INC. | P. O. BOX 50435 INDIANAPOLIS, IN 46250 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 1.99% |
| RONALD F REMAK INSURANCE INC3 Filed as: RONALD F REMAK INSURANCE INC. | 306 STATE ROAD 446 BLOOMINGTON, IN 47401 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.41% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $383 | $58 | $441 | 0.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA, INC. | P. O. BOX 601478 CHARLOTTE, NC 28260 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $153 | — | $153 | 0.04% |
| ERNEST FALCO3 | 350 CROWN OAK CENTRE DRIVE LONGWOOD, FL 32750 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $127 | — | $127 | 0.04% |
| BULLOCK, KATHERINE, WATTS3 | 1308 SILVERPOINT ROAD CHAPIN, SC 29036 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.01% |
| FISHER, MARY, ELIZABETH3 | 8644 DE LOSS DRIVE RIVERSIDE, CA 92508 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.00% |
| ASSUREX3 | 175 S. THIRD STREET, STE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $9 | $9 | 0.00% |
| DISCOVERY BENEFIT SOLUTIONS3 Filed as: DISCOVERY BENEFITS SOLUTIONS | 8880 RIO SAN DIEGO DR., STE 790 SAN DIEGO, CA 921081682 | KAISER FOUNDATION HEALTH PLAN INC. | $8K | — | $8K | 3.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 8880 RIO SAN DIEFO DR., STE 790 SAN DIEGO, CA 921081682 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 8880 RIO SAN DIEGO DR., STE 790 SAN DIEGO, CA 921081682 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.48% |
| DISCOVERY BENEFIT SOLUTIONS3 | 8880 RIO SAN DIEGO DR., STE 790 SAN DIEGO, CA 921081682 | PRINCIPAL LIFE INSURANCE COMPANY | $853 | — | $853 | 3.30% |
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 | 8,154 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 8,154 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HIGHMARK INC. | 187 | $2.0M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 180 | $78K |
| Vision(2 contracts, 2 carriers) | HIGHMARK INC. | 187 | $1.8M |
| Life insurance(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,104 | $3.5M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 4,877 | $2.3M |
| Long-term disability(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,104 | $3.2M |
| Prescription drug | HIGHMARK INC. | 187 | $1.8M |
| Other(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,104 | $3.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,104 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.