| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENFITS | BERWYN AVE STE 200 BERWYN, PA 19312 | UNITED CONCORDIA INSURANCE COMPANY | $254 | $0 | $254 | 13.25% |
| TRINITY BENEFIT ADVISORS, INC.3 Filed as: TRINITY BENEFIT ADVISORS | 660 AMERICAN AVE STE 101 KING OF PRUSSIA, PA 19406 | EYEMED | $0 | $0 | $0 | — |
| ENROLLEASE3 Filed as: ONE DIGITAL | 200 GALLERIA PKWY 1950 ATLANTA, GA 30339 | EYEMED | $0 | $0 | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRINITY BENEFIT ADVISORS BROKER | Insurance agents and brokers Service code 22 | 660 AMERICAN AVE STE 101 KING OF PRUSSIA, PA 19406 | $3K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $2K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVISOR | Other services Service code 49 | — | $370 |
| INDEPENDENCE ADMINISTRATORS EIN 23-2184623 ADMIN | Claims processing Service code 12 | — | $0 |
| TELEMEDICINE MAMAGEMENT, INC. DBA S EIN 26-1306606 PATIENT ADVISOR | Other services Service code 49 | — | $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 | 74 | 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) | 74 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 68 | $2K |
| Vision | EYEMED | 56 | $0 |
| Life insurance | TRANSAMERICA LIFE INSURANCE COMPANY | 0 | $0 |
| Short-term disability | TRANSAMERICA LIFE INSURANCE COMPANY | 0 | $0 |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 74 | $13K |
| Other | TRANSAMERICA LIFE INSURANCE COMPANY | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 74 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.