| 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 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | $2K | $17K | 2.85% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENF GENERAL AGENCY | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $2K | $16K | 2.63% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS GENERAL | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $4K | $16K | 2.56% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $508 | $7K | 1.08% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26K | $9K | $35K | 11.97% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENF GENERAL AGENCY | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $25K | — | $25K | 8.45% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $606 | $12K | 3.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 233L SOUTH WACKER DRIVE, SUITE 2000 CHICAGO, IL 60606 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 1.35% |
| ASSUREX3 | 175 SOUTH 3RD STREET, SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $505 | $505 | 0.17% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | NGL | $4K | — | $4K | 10.00% |
| LYONS COMPANIES3 | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | HEALTHIEST YOU | $1K | — | $1K | 15.01% |
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 | 657 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 668 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHIEST YOU | 250 | $7K |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 983 | $275K |
| Vision | NGL | 869 | $43K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,168 | $615K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,545 | $293K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,168 | $615K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,545 | $915K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,545 | — |
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.