| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRACEY KEISER | 8181 E. KAISER BLVD ANAHEIM HILLS, CA 92808 | NATIONWIDE | $88K | — | $88K | 20.00% |
| FRINGE INSURANCE BENEFITS, INC. Filed as: FRINGE INSURANCE BENEFITS INC | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | NATIONWIDE | $11K | — | $11K | 2.50% |
| ASSUREDPARTNERS3 Filed as: HDH GROUP INC | 1007 MUMMA ROAD STE 200 WORMLEYSBURG, PA 17043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $13K | — | $13K | 5.00% |
| ASSUREDPARTNERS3 Filed as: HDH GROUP INC | 1007 MUMMA ROAD STE 200 WORMLEYSBURG, PA 17043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 3.13% |
| TRACEY KEISER | 8181 E. KAISER BLVD ANAHEIM HILLS, CA 92808 | COMPANION LIFE INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| FRINGE INSURANCE BENEFITS, INC. Filed as: FRINGE INSURANCE BENEFITS INC | 11910 ANDERSON MILL ROAD STE 401 AUSTIN, TX 78726 | COMPANION LIFE INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| ASSUREDPARTNERS3 Filed as: HDH GROUP INC | 1007 MUMMA ROAD STE 200 WORMLEYSBURG, PA 17043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $12K | — | $12K | 15.00% |
| ASSUREDPARTNERS3 Filed as: HDH GROUP INC | 1007 MUMMA ROAD STE 200 WORMLEYSBURG, PA 17043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| ASSUREDPARTNERS3 Filed as: HDH GROUP INC | 1007 MUMMA ROAD STE 200 WORMLEYSBURG, PA 17043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | — | $8K | 15.00% |
| ASSUREDPARTNERS3 Filed as: HDH GROUP INC | 1007 MUMMA ROAD STE 200 WORMLEYSBURG, PA 17043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 11.00% |
| ASSUREDPARTNERS Filed as: THE HDH GROUP INC | 1007 MUMMA RD STE 200 WORMLEYSBURG, PA 17043 | VISION SERVICE PLAN | $4K | — | $4K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE KEISER GROUP EIN 47-3366074 NONE | Consulting (general); Consulting fees Service code 16 | — | $67K |
| KG ADMINISTRATIVE SERVICES, INC EIN 47-3366074 NONE | Claims processing; Contract Administrator Service code 12 | — | $52K |
| THE HDH GROUP EIN 25-1428002 NONE | Consulting (general); Consulting fees Service code 16 | — | $39K |
| FIRST HEALTH NETWORK PHX-PPO EIN 27-2962558 NONE | Other fees Service code 99 | — | $8K |
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 | 807 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 810 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HIGHMARK BLUE SHIELD MEDICAL | 585 | $3.7M |
| Dental(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 474 | $327K |
| Vision | VISION SERVICE PLAN | 603 | $0 |
| Life insurance(3 contracts, 2 carriers) | GEISINGER HEALTH PLAN | 2,352 | $287K |
| Short-term disability | GEISINGER HEALTH PLAN | 40 | $194K |
| Long-term disability(2 contracts, 2 carriers) | GEISINGER HEALTH PLAN | 218 | $246K |
| Other(4 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,352 | $308K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,352 | — |
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.