| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMERICAN INSURANCE ADMINISTRATORS3 | 4550 LENA DRIVE MECHANICSBURG, PA 17055 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $45K | — | $45K | 2.66% |
| AMERICAN INSURANCE ADMINISTRATORS3 | 4550 LENA DRIVE MECHANICSBURG, PA 17055 | DELTA DENTAL OF PENNSYLVANIA | $6K | — | $6K | 6.00% |
| AMERICAN INSURANCE ADMINISTRATORS3 | 4550 LENA DRIVE MECHANICSBURG, PA 17055 | PRUDENTIAL | $16K | — | $16K | 18.43% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE, STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL | — | $63 | $63 | 0.07% |
| AMERICAN INSURANCE USA3 | 122 SOUTH LENA DRIVE MECHANICSBURG, PA 17055 | PRUDENTIAL | $4K | — | $4K | 15.00% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE, STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL | — | $22 | $22 | 0.08% |
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 | 195 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 192 | $106K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 196 | $1.7M |
| Life insurance(2 contracts) | PRUDENTIAL | 195 | $116K |
| Short-term disability(2 contracts) | PRUDENTIAL | 195 | $116K |
| Long-term disability(2 contracts) | PRUDENTIAL | 195 | $116K |
| Prescription drug | CAPITAL ADVANTAGE ASSURANCE COMPANY | 196 | $1.7M |
| Stop-loss / reinsurancereinsurance | AVALON INSURANCE COMPANY | 194 | $181K |
| Other(2 contracts) | PRUDENTIAL | 195 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.