| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $5K | $0 | $5K | 8.60% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 Filed as: PENNSYLVANIA AUTO ASSOC INS | 1925 N FRONT ST 1925 N FRONT ST HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 7.87% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 8.69% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 Filed as: PENNSYLVANIA AUTO ASSOC INS | C/O JOHN KULP HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 7.90% |
| ASSURANCE AGENCY LTD3 Filed as: AMEREICAN FIDELITY ASSURANCE CO | 7 STATE CR 301 ANNAPOLIS, MD 21401 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 15.67% |
| MADS INSURANCE AGENCY3 Filed as: MADS INSURANCE AGCY | 7 STATE ST CR 301 ANNAPOLIS, MD 21401 | AMERICAN FIDELITY ASSURANCE COMPANY | $353 | $0 | $353 | 4.96% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $36 | $0 | $36 | 1.05% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $34 | $0 | $34 | 0.99% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A BAY ST LOUIS, MS 39520 | ALLSTATE BENEFITS | $23 | $0 | $23 | 0.67% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $22 | $0 | $22 | 0.64% |
| WAACK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $22 | $0 | $22 | 0.64% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $38 | $0 | $38 | 1.32% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $34 | $0 | $34 | 1.19% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $25 | $0 | $25 | 0.87% |
| WAACK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $25 | $0 | $25 | 0.87% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A BAY ST LOUIS, PA 39520 | ALLSTATE BENEFITS | $18 | $0 | $18 | 0.63% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A BAY ST LOUIS, MS 39520 | ALLSTATE BENEFITS | $28 | $0 | $28 | 1.48% |
| TROCKI GEORGE3 | 221 PROSPECT CIR SHREWSBURY, PA 17361 | ALLSTATE BENEFITS | $10 | $0 | $10 | 0.53% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $19 | $0 | $19 | 1.75% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $13 | $0 | $13 | 1.20% |
| WAACK KAY3 | 1263 LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $13 | $0 | $13 | 1.20% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $8 | $0 | $8 | 1.18% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $8 | $0 | $8 | 1.18% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $5 | $0 | $5 | 0.74% |
| WAAK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $5 | $0 | $5 | 0.74% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A BAY ST LOUIS, MS 39520 | ALLSTATE BENEFITS | $13 | $0 | $13 | 2.17% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $6 | $0 | $6 | 1.00% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCH HAVEN, PA 17745 | ALLSTATE BENEFITS | $5 | $0 | $5 | 0.83% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $4 | $0 | $4 | 0.67% |
| WAACK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $4 | $0 | $4 | 0.67% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $9 | $0 | $9 | 1.60% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $9 | $0 | $9 | 1.60% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $6 | $0 | $6 | 1.07% |
| WAAK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $6 | $0 | $6 | 1.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMONWEALTH BENEFITS GROUP EIN 23-2399040 BROKER | Insurance agents and brokers Service code 22 | 2 BARLOW CIR # C DILLSBURG, PA 17019 | $41K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $21K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $7K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $6K |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $0 |
| Short-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 57 | $101K |
| Long-term disability(3 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 57 | $108K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 96 | $335K |
| Other(11 contracts, 3 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 57 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 96 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.