| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENROLLMENT RESOURCES GROUP3 | 233 S WACKER DR STE 1875 CHICAGO, IL 60603 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.71% |
| SWETT & CRAWFORD OF ILLINOIS, INC.3 Filed as: SWETT AND CRAWFORD OF IL, INC. | ONE N. FRANKLIN ST., 14TH FL. CHICAGO, IL 60606 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.51% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PRGRMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MN INC. | P.O. BOX 93076 CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
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 | 1,656 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,673 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 277 | $81K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,887 | $479K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 277 | $81K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,887 | $398K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 3,380 | $349K |
| Other | HARTFORD LIFE AND ACCIDENT | 1,887 | $398K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,380 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.