| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | — | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 8.33% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | $0 | $2K | 3.93% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | — | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | $0 | $2K | 8.55% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | -$1K | $0 | -$1K | -4.37% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MPB RISK SERVICES, LLC EIN 85-0556241 ADMIN | Claims processing Service code 12 | — | $27K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $25K |
| COMMONWEALTH BENEFITS GROUP EIN 23-2399040 BROKER | Insurance agents and brokers Service code 22 | — | $5K |
| CAPITAL BLUECROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | -$19K |
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 | 70 | 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) | 70 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN FIDELITY ASSURANCE COMPANY | 51 | $41K |
| Short-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 51 | $66K |
| Long-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 51 | $66K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 70 | $358K |
| Other(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 51 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 70 | — |
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."
No prospect flags tripped on this filing.