| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $301 | $211 | $512 | 2.17% |
| JOHN GEOLAS3 Filed as: JOHN D CUNNINGHAM | 1900 W 63RD STREET MISSION HILLS, KS 66208 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $156 | — | $156 | 0.66% |
| JO ANN PANTALONE3 | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $50 | — | $50 | 0.21% |
| INSURANCE DESIGN GROUP INC3 Filed as: INSURANCE DESIGN GROUP INC. | 7611 STATE LINE ROAD, SUITE 250 KANSAS CITY, MO 64114 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $45 | — | $45 | 0.19% |
| LOUIS R FAIOLA3 Filed as: LOUIS J PANTALONE | PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.11% |
| ERNEST FALCO3 | 350 CROWN OAK CENTRE DRIVE LONGWOOD, FL 32750 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.08% |
| LOCKTON COMPANIES, LLC3 | PO BOX 843844 KANSAS CITY, MO 64184 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 17.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $1.1M |
| AETNA BEHAVIORAL HEALTH, LLC CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $156K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $39K |
| MATRIX ABSENCE MANAGEMENT, INC. EIN 77-0493584 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $36K |
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 | 13,337 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 81 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 13,418 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 863 | $2.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 4 | $62K |
| Vision | VISION SERVICE PLAN | 5,191 | $306K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 8,792 | $451K |
| Short-term disability(2 contracts, 2 carriers) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 217 | $15K |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 7,001 | $444K |
| Other(6 contracts, 6 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 3,276 | $433K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,792 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.