| 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 | $46K | $14K | $60K | 24.78% |
| ENROLLMENT RESOURCES GROUP3 | 233 SOUTH WACKER DRIVE, SUITE 1875 CHICAGO, IL 60603 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18K | — | $18K | 7.58% |
| LYONS COMPANIES3 | ONE RIGHTER PARKWAY, SUITE 110 WILMINGTON, DE 19803 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15K | $2K | $17K | 7.04% |
| ASSUREX3 | 175 SOUTH THIRD STREET, SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $173 | $173 | 0.07% |
| LYONS COMPANIES3 | ONE RIGHTER PARKWAY, SUITE 110 WILMINGTON, DE 19803 | DELTA DENTAL OF PENNSYLVANIA | $11K | — | $11K | 4.44% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $39K | $9K | $49K | 25.71% |
| LYONS COMPANIES3 | ONE RIGHTER PARKWAY, SUITE 110 WILMINGTON, DE 19803 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $20K | $3K | $23K | 11.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS, INC. | 233 SOUTH WACKER DRIVE CHICAGO, IL 60606 | TRANSAMERICA | $16K | — | $16K | 19.99% |
| LYONS COMPANIES3 | ONE RIGHTER PARKWAY, SUITE 110 WILMINGTON, DE 19803 | TRANSAMERICA | $7K | — | $7K | 8.57% |
| LYONS COMPANIES3 | ONE RIGHTER PARKWAY, SUITE 110 WILMINGTON, DE 19803 | NATIONAL VISION ADMINISTRATORS, L.L.C. | $4K | — | $4K | 10.00% |
| LYONS COMPANIES3 | ONE RIGHTER PARKWAY, SUITE 100 WILMINGTON, DE 19803 | HEALTHIEST YOU | $4K | — | $4K | 15.00% |
| LYONS COMPANIES3 | ONE RIGHTER WAY, SUITE 110 WILMINGTON, DE 19803 | METROPOLITAN LIFE INSURANCE COMPANY | — | — | $0 | — |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC. | PO BOX 13784 NEWARK, NJ 07188 | METROPOLITAN LIFE INSURANCE COMPANY | — | — | $0 | — |
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 | 593 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 599 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRANSAMERICA | 200 | $107K |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 874 | $241K |
| Vision | NATIONAL VISION ADMINISTRATORS, L.L.C. | 795 | $40K |
| Life insurance(3 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,359 | $432K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,359 | $241K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 870 | $190K |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,359 | $432K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,359 | — |
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.