| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $2K | $15K | 4.25% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $2K | $11K | 3.35% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $2K | $11K | 3.27% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $2K | $9K | 2.59% |
| ENROLLEASE3 Filed as: ONEDIGITAL PREMIER SERVICES | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 1.27% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 | 555 FAIRMONT AVENUE BALTIMORE, PA 21286 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 0.59% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $803 | $0 | $803 | 0.24% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26K | $2K | $28K | 12.31% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18K | $2K | $21K | 9.26% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18K | $2K | $20K | 9.12% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 1.39% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $23 | $2K | 0.86% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 233 SOUTH WACKER DRIVE, SUITE 2000 CHICAGO, IL 60606 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 0.81% |
| ASSUREX3 | 175 SOUTH 3RD STREET, SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $2K | $2K | 0.69% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 | 555 FAIRMONT AVENUE BALTIMORE, MD 21286 | NATIONAL VISION ADMINISTRATORS, LLC | $16K | $2K | $18K | 61.23% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | NATIONAL VISION ADMINISTRATORS, LLC | $13K | $1K | $14K | 48.77% |
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 | 691 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 693 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 894 | $236K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 845 | $30K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,001 | $565K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 970 | $224K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,001 | $565K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,001 | $565K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,001 | — |
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.