| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RIGGS COUNSELMAN MICHAELS & DOWNES3 | 555 FAIRMONT AVENUE BALTIMORE, MD 21286 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $20K | $703 | $21K | 5.25% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $868 | $9K | 2.17% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $868 | $9K | 2.17% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $265 | $3K | 0.81% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $32 | $0 | $32 | 0.01% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 1 NORTH WHITE HORSE PIKE, SUITE 2 HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $20 | $0 | $20 | 0.00% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 | 555 FAIRMONT AVENUE BALTIMORE, DE 21286 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $29K | $0 | $29K | 9.30% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21K | $2K | $23K | 7.35% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21K | $2K | $23K | 7.35% |
| LYONS INSURANCE AGENCY INC3 Filed as: LYONS INSURANCE AGENCY, INC. | 501 CARR ROAD, SUITE 301 WILMINGTON, DE 19809 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $546 | $11K | 3.37% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 1 NORTH WHITE HORSE PIKE, SUITE 2 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 0.79% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BEN. & OTHER AGENTS | 400 BERWYN PARK, SUITE 200 BERWYN, PA 19312 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $926 | $455 | $1K | 0.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 35371 NETWORK PLACE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 0.38% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 | 555 FAIRMONT AVENUE BALTIMORE, MD 21286 | NATIONAL VISION ADMINISTRATORS, LLC | $3K | $0 | $3K | 10.00% |
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 | 781 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 784 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 992 | $292K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 963 | $32K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 236 | $402K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 236 | $402K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,283 | $714K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,283 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.