| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 Filed as: PENNSYLVANIA AUTO ASSOC INS | C/O JOHN KULP HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 7.62% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 3.19% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $23 | $0 | $23 | 0.96% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $22 | $0 | $22 | 0.92% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A BAY ST LOUIS, MS 39520 | ALLSTATE BENEFITS | $20 | $0 | $20 | 0.84% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $14 | $0 | $14 | 0.59% |
| WAACK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $14 | $0 | $14 | 0.59% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $24 | $0 | $24 | 1.19% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $22 | $0 | $22 | 1.09% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $16 | $0 | $16 | 0.79% |
| WAACK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $16 | $0 | $16 | 0.79% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A BAY ST LOUIS, PA 39520 | ALLSTATE BENEFITS | $15 | $0 | $15 | 0.74% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $12 | $0 | $12 | 1.76% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $11 | $0 | $11 | 1.62% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $8 | $0 | $8 | 1.17% |
| WAACK KAY3 | 1263 LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $8 | $0 | $8 | 1.17% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVE STE 3A ST LOUIS, MS 39520 | ALLSTATE BENEFITS | $51 | $0 | $51 | 8.17% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $6 | $0 | $6 | 1.21% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCK HAVEN, PA 17745 | ALLSTATE BENEFITS | $6 | $0 | $6 | 1.21% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $4 | $0 | $4 | 0.81% |
| WAAK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $4 | $0 | $4 | 0.81% |
| BROOKS CONSULTANTS INC3 | 101 COPPER BEECH LANE WOMELSDORF, PA 19567 | ALLSTATE BENEFITS | $6 | $0 | $6 | 1.58% |
| R & B INSURANCE SERVICES LLC3 Filed as: R&B INSURANCE SERVICES LLC | 209 WOODWARD AVE LOCH HAVEN, PA 17745 | ALLSTATE BENEFITS | $5 | $0 | $5 | 1.32% |
| RANCK DAVID3 | 148 GERY CT EPHRATA, PA 17522 | ALLSTATE BENEFITS | $4 | $0 | $4 | 1.06% |
| WAACK KAY3 | 1263 W LEESPORT RD LEESPORT, PA 19533 | ALLSTATE BENEFITS | $4 | $0 | $4 | 1.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMONWEALTH BENEFITS GROUP EIN 23-2399040 BROKER | Insurance agents and brokers Service code 22 | — | $41K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $22K |
| CAPITAL BLUECROSS 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 | 87 | 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) | 87 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ALLSTATE BENEFITS | 2 | $624 |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 52 | $44K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 52 | $44K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 87 | $389K |
| Other(6 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 52 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 87 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.