| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC Filed as: LOCKTON COMPANIES,LLC | 444 W. 47TH STREET SUITE 400 KANSAS CITY, MO 64112 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | — |
| CUSTOM BENEFIT PROGRAMS INC Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8K | $1K | $9K | — |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS OF FLORIDA, INC. | 29848 NETWORK PL. CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $736 | — | $736 | — |
| ROSE & KIERNAN INC Filed as: ROSE & KIERNAN, INC. | P.O. BOX 640 EAST GAREENBUSH, NY 12061 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $653 | — | $653 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 VENDOR | Other services; Direct payment from the plan; Float revenue; Trustee (bank, trust company, or similar financial institution); Named fiduciary; Participant communication; Contract Administrator; Claims processing; Non-monetary compensation Service code 12 | 900 COTTAGE GROVE RD BLOOMFIELD, CT 06152 | $218K |
| AMERICAN SPECIALTY HEALTH EIN 33-0571188 VENDOR | Non-monetary compensation; Contract Administrator; Other services; Claims processing; Named fiduciary; Float revenue; Participant communication; Direct payment from the plan Service code 12 | 10221 WATERIDGE CIR 201 SAN DIEGO, CA 92121 | $0 |
| CARECORE / EVICORE EIN 14-1831391 VENDOR | Other services; Claims processing; Float revenue; Participant communication; Named fiduciary; Non-monetary compensation; Contract Administrator; Direct payment from the plan Service code 12 | 400 BUCKWALTER PLACE BLVD BLUFFTON, SC 29910 | $0 |
| CASTLIGHT HEALTH EIN 26-1989091 VENDOR | Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; Contract Administrator; Participant communication; Named fiduciary; Other services Service code 12 | 121 SPEAR STREET 3RD FLOOR SAN FRANCISCO, CA 94105 | $0 |
| SAGAMORE NETWORK HOSPITAL LISTING EIN 35-1720796 VENDOR | Direct payment from the plan; Named fiduciary; Float revenue; Other services; Claims processing; Non-monetary compensation; Contract Administrator; Participant communication Service code 12 | POST OFFICE BOX 1149 BLOOMINGTON, IN 47402 | $0 |
| STRATOSE EIN 26-1790538 VENDOR | Contract Administrator; Float revenue; Direct payment from the plan; Non-monetary compensation; Other services; Named fiduciary; Claims processing; Participant communication Service code 12 | TWO CONCOURSE PARKWAY SUITE 300 ATLANTA, GA 30328 | $0 |
| VISION SERVICE PLAN EIN 06-1227840 VENDOR | Participant communication; Float revenue; Named fiduciary; Claims processing; Other services; Direct payment from the plan; Contract Administrator; Non-monetary compensation Service code 12 | 333 QUALITY DRIVE RANCHO CORDOVA, CA 96670 | $0 |
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 | 222 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 614 | $0 |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 342 | $0 |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 276 | $0 |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 342 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 614 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.