| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 30 WATERSIDE DRIVE FARMINGTON, IL 06034 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $44K | $4K | $49K | 11.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $28K | $0 | $28K | 6.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $2K | $2K | 0.36% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $107K | $3K | $110K | 26.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 650 EAST CARMEL DRIVE, SUITE 400 CARMEL, IN 46032 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $46K | $6K | $52K | 12.63% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B. KELLY INS. SERVICES INC. | PO BOX 222634 CARMEL, CA 93922 | HUMANA INSURANCE COMPANY | $23K | $0 | $23K | 9.38% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B. KELLY INS. SERVICES INC. | PO BOX 222634 CARMEL, CA 93922 | VISION SERVICE PLAN | $7K | $0 | $7K | 9.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $244 | $0 | $244 | 6.30% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 30 WATERSIDE DRIVE FARMINGTON, CT 06034 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $205 | — | $205 | 5.30% |
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 | 285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 63 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 348 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HUMANA INSURANCE COMPANY | 285 | $245K |
| Vision | VISION SERVICE PLAN | 260 | $74K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 609 | $674K |
| Other(5 contracts, 5 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 2,633 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,633 | — |
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.