| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE DBJ GROUP INC3 | 231 CHESTNUT STREET STE 200 MEADVILLE, PA 16335 | VISION BENEFITS OF AMERICA | $315 | $0 | $315 | — |
| THE DBJ GROUP INC3 | 231 CHESTNUT STREET SUITE 410 MEADVILLE, PA 16335 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $0 | $3K | — |
| THE DBJ GROUP INC3 | 231 CHESTNUT STREET SUITE 410 MEADVILLE, PA 16335 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $463 | $0 | $463 | — |
| THE DBJ GROUP INC3 | 231 CHESTNUT STREET SUITE 410 MEADVILLE, PA 16335 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $0 | $7K | — |
| THE DJB GROUP3 Filed as: DJB GROUP | 262 CHESTNUT ST SUITE 200 MEADVILLE, PA 16335 | HM LIFE INSURANCE COMPANY | $28K | $0 | $28K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERITAS LIFE INSURANCE EIN 47-0098400 ADMIN | Claims processing Service code 12 | PO BOX 81889 LINCOLN, NE 68501 | $8K |
| THE DBJ GROUP INC EIN 25-1708669 BROKER | Insurance agents and brokers Service code 22 | 262 CHESTNUT STREET SUITE 200 MEADVILLE, PA 16335 | $2K |
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | 210 6TH AVE 30TH FLOOR PITTSBURGH, PA 15222 | $0 |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION BENEFITS OF AMERICA | 165 | $0 |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $0 |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $0 |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 0 | $0 |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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."
No prospect flags tripped on this filing.