| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $69K | $18K | $87K | 27.94% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES MN INC | 9655 SCHMIDT LAKE ROAD PLYMOUTH, MN 55442 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | $96 | $9K | 2.92% |
| ENROLLEASE3 Filed as: THE KNW GROUP, LLC | 4350 BAKER ROAD SUITE 250 HOPKINS, MN 55434 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $58 | $555 | $613 | 0.20% |
| BENEFIT ASSOCIATES INC.3 Filed as: BENEFIT ASSOCIATES INC | 1008 WEST 8TH AVE SUITE E KING OF PRUSSIA, PA 19406 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $590 | $0 | $590 | 0.19% |
| JO ANN PANTALONE3 | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $590 | $0 | $590 | 0.19% |
| LORRAINE R MOORE3 | 1150 FIRST AVENUE SUITE 100 KING OR PRUSSIA, PA 19406 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $445 | $0 | $445 | 0.14% |
| NFP INSURANCE SERVICES INC3 | 1250 CAPITAL OF TX HWY BUILDING 2, SUITE 125 AUSTIN, TX 78746 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $211 | $211 | 0.07% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES MN INC | 9655 SCHMIDT LAKE RD PYMOUTH, MN 55442 | STANDARD INSURANCE COMPANY | $28K | $0 | $28K | 11.01% |
| NFP INSURANCE SERVICES INC3 | 1250 CAPITAL OF TX HWY SUITE 125, BLDG 2 AUSTIN, TX 78746 | STANDARD INSURANCE COMPANY | $0 | $4K | $4K | 1.44% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS CO | 897 12TH STREET HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $53K | $9K | $62K | 32.01% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES MN INC | 9655 SCHMIDT LAKE ROAD PLYMOTH, MN 55442 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $676 | $8K | 4.12% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES MN INC | 9655 SCHMIDT LAKE ROAD PLYMOUTH, MN 55442 | AMERITAS LIFE INSURANCE CORPORATION | $3K | $0 | $3K | 3.11% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES MN INC | 9655 SCHMIDT LAKE ROAD PLYMOUTH, MN 55442 | DELTA DENTAL OF MINNESOTA | $2K | $0 | $2K | 2.25% |
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 | 2,693 | 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) | 2,693 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MINNESOTA | 218 | $82K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 1,705 | $105K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 2,693 | $566K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,481 | $313K |
| Long-term disability | STANDARD INSURANCE COMPANY | 2,693 | $253K |
| Other(3 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 2,693 | $761K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,693 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.