| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $12K | $4K | $15K | 5.80% |
| PANTALONE, JO, ANN3 Filed as: PANTALONE, LOUIS, J | CUSTOM BENEFITS PROGRAMS INC PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 0.98% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | 93245 NETWORK PL CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.45% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS-TAMPA | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $598 | — | $598 | 0.23% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS-LAKE MARY | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $593 | — | $593 | 0.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | PO BOX 93234 CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.01% |
| CFN AGENCY INC3 Filed as: CFN AGENCY INC. | 4450 RIVER FREEN PKWY STE 100A DULUT, GA 30096 | AETNA LIFE INSURANCE COMPANY | $10K | — | $10K | 5.20% |
| PANTALONE, JO, ANN3 Filed as: PANTALONE, LOUIS, J | CUSTOM BENEFIT PROGRAMS INC PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $67 | — | $67 | 1.61% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $41 | — | $41 | 0.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | PO BOX 93234 CHICAGO, IL 60673 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $12 | — | $12 | 0.29% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS - TAMPA | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3 | — | $3 | 0.07% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | FIRST UNUM LIFE INSURANCE COMPANY | $98 | — | $98 | 4.19% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS-LAKE MARY | 4565 PAYSHPERE CIRCLE CHICAGO, IL 60674 | FIRST UNUM LIFE INSURANCE COMPANY | $20 | — | $20 | 0.86% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS-LAKE MARY | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $137 | $6 | $143 | 11.50% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $46 | $36 | $82 | 6.60% |
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 | 24,226 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 113 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 24,339 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF HAWAII | 2 | $12K |
| Dental | AETNA LIFE INSURANCE COMPANY | 333 | $195K |
| Vision(4 contracts, 3 carriers) | COMBINED INSURANCE COMPANY OF AMERICA | 7,714 | $729K |
| Life insurance(4 contracts, 4 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 6,889 | $1.0M |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 10 | $2K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 6,650 | $1.1M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF HAWAII | 2 | $12K |
| Other(7 contracts, 6 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 24,226 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 24,226 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.