| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFLIATES | $79K | $10K | $89K | 3.37% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $11K | $0 | $11K | 10.00% |
| LOCKTON COMPANIES, LLC3 | PO BOX 123042 DALLAS, TX 75312 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.23% |
| LOCKTON COMPANIES, LLC3 | 2 EMBARCADERO CENTER, SUITE 1700 SAN FRANCISCO, CA 94111 | TRANSAMERICA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 7.80% |
| PCF INSURANCE SERVICES OF THE WEST3 | 6200 CANOGA AVENUE, SUITE 325 WOODLAND HILLS, CA 91367 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 6.06% |
| HODGES-MACE LLC3 | 5775 EAST GLENRIDGE DRIVE SUITE 500 ATLANTA, GA 30328 | TRANSAMERICA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 1.97% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $486 | $867 | $1K | 9.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: CRAGIN AND PIKE INC. | 2603 WEST CHARLESTON BOULEVARD LAS VEGAS, NV 89102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $107 | $0 | $107 | 0.75% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN INSURANCE OF NEVADA | 975 KELLY JOHNSON DRIVE LAS VEGAS, NV 89119 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $47 | $0 | $47 | 0.33% |
| EBC, INC.3 Filed as: EBC INC. | PO BOX 20443 INDIANAPOLIS, IN 46220 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.12% |
| HODGES-MACE BENEFITS GRP INC3 Filed as: HODGES-MACE BENEFITS GROUP INC. | 5775 EAST GLENRIDGE DRIVE SUITE 3500 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.09% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.06% |
| MARK METTILLE3 Filed as: MARK J. MATSOCK AND ASSOCIATES INC. | 2400 EAST ARIZONA BILTMORE CIRCLE SUITE 1100 PHOENIX, AZ 85016 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.03% |
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 | 148 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFLIATES | 172 | $2.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFLIATES | 172 | $2.6M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 386 | $5K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 184 | $126K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 184 | $111K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 184 | $111K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFLIATES | 172 | $2.6M |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 617 | $166K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 617 | — |
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."
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.