| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY OF V | 11220 ASSET LOOP STE 304 MANASSAS, VA 20109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $382 | $382 | 1.27% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES IN | 6711 COLUMBIA GATEWAY DR STE 450 COLUMBIA, MD 21046 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $163 | $0 | $163 | 0.54% |
| ENGLE-HAMBRIGHT & DAVIES, INC.3 | 1857 WILLIAM PENN WAY PO BOX 11600 LANCASTER, PA 17605 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $139 | $0 | $139 | 0.46% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES IN | 6711 COLUMBIA GATEWAY DR COLUMBIA, MD 21046 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 8.28% |
| ENGLE-HAMBRIGHT & DAVIES, INC.3 Filed as: ENGLE-HAMBRIGHT & DAVIES INC | 1857 WILLIAM PENN WAY PO BOX 11600 LANCASTER, PA 17605 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 6.72% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY OF V | 11220 ASSET LOOP STE 304 MANASSAS, VA 20109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $320 | $320 | 1.55% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 600 W GERMANTOWN PIKE STE 171 PLYMOUTH MEETING, PA 19462 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.01% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 600 W GERMANTOWN PIKE STE 171 PLYMOUTH MEETING, PA 19462 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.03% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 600 W GERMANTOWN PIKE STE 171 PLYMOUTH MEETING, PA 19462 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 ADMIN | Claims processing Service code 12 | — | $97K |
| DELTA DENTAL OF PENNSYLVANIA EIN 23-1667011 ADMIN | Claims processing Service code 12 | — | $18K |
| HAYS COMPANIES INC BROKER | Insurance agents and brokers Service code 22 | 80 SOUTH 8TH ST STE 700 MINNEAPOLIS, MN 55402 | $14K |
| ENGLE-HAMBRIGHT & DAVIES INC EIN 23-0558310 BROKER | Insurance agents and brokers Service code 22 | — | $841 |
| NATIONAL VISION ADMINISTRATORS, LLC EIN 74-3033381 ADMIN | Claims processing Service code 12 | — | $465 |
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 | 153 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 154 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $30K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $4K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $21K |
| Other(5 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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.