| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVE., STE. 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 3.39% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 1.96% |
| EOI SERVICE COMPANY INC3 Filed as: EOI SERVICES COMPANY, INC. | 1820 E. 1ST ST. SANTA ANA, CA 92705 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $411 | — | $411 | 0.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS PPO NETWORK EIN 95-4331852 ADMINISTRATION | Claims processing Service code 12 | — | $581K |
| DELTA HEALTH SYSTEMS EIN 94-2353289 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $535K |
| ANTHEM BLUE CROSS JAA FEES-PPO NET EIN 95-4331852 ADMINISTRATION | Claims processing Service code 12 | — | $69K |
| REGENCE BLUE CROSS/BLUE SHIELD EIN 93-0238155 CLAIMS PROCESSING SERVI | Sub-transfer agency fees; Claims processing; Direct payment from the plan Service code 12 | — | $61K |
| RELIANCE STANDARD LIFE INS. CO. EIN 36-0883760 NONE | Claims processing Service code 12 | — | $47K |
| VISION SERVICE PLAN EIN 94-1632821 ADMINISTRATION | Claims processing Service code 12 | — | $26K |
| DELTA HEALTH SYSTEMS DM EIN 94-2353289 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $25K |
| DELTA HEALTH SYSTEMS-DM FSA EIN 94-2353289 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $16K |
| DELTA HEALTH SYSTEMS COBRA EIN 94-2353289 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $15K |
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 | 2,208 | 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. |
| Total participants (= "Plan participants" tile) | 2,208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 2,201 | $263K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 2,173 | $344K |
| Short-term disability | STANDARD INSURANCE COMPANY | 2,123 | $244K |
| Long-term disability | STANDARD INSURANCE COMPANY | 2,117 | $60K |
| Other(4 contracts, 4 carriers) | HM LIFE INSURANCE COMPANY | 2,208 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,208 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.