| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1018 W 9TH AVE STE 100 KING OF PRUSSIA, PA 19406 | UNITED HEALTHCARE INSURANCE COMPANY | $24K | $0 | $24K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | PO BOX 823221 PHILADELPHIA, PA 191823221 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | $0 | $8K | 10.46% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $40 | $40 | 0.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONA | 580 N. 4TH STREET SUITE 400 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 4.15% |
| PENTRA LLC3 Filed as: PENTRA INC | 795 E LANCASTER AVENUE SUITE 210 VILLANOVA, PA 19085 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $107 | $0 | $107 | 0.15% |
| INDEPENDENCE PLANNING GROUP3 Filed as: INDEPENDENCE PLANNING GROUP, L | 1767 SENTRY PKWY W BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1 | $0 | $1 | 0.00% |
| PENTRA LLC3 | 795 E LANCASTER AVE STE 210 VILLANOVA, PA 190851525 | VISION SERVICE PLAN | $87 | $0 | $87 | 0.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMHEALTH FINANCIAL SERVICES EIN 47-0858530 NONE | Contract Administrator; Claims processing Service code 12 | — | $3K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 NONE | Other services; Other fees; Contract Administrator Service code 13 | — | $854 |
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 | 147 | 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) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 144 | $606K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 96 | $72K |
| Vision | VISION SERVICE PLAN | 95 | $13K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 147 | $73K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 147 | $73K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 147 | $73K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 147 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 147 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.