| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DH EVANS TPA, LLC5 | 4785 LINGLESTOWN RD, STE 200 HARRISBURG, PA 17112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 5.00% |
| DH EVANS TPA, LLC5 | 4785 LINGLESTOWN RD, STE 200 HARRISBURG, PA 17112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 5.00% |
| EJO III INC3 Filed as: EJO III, INC. DBA C.A. WEBER AGENCY | 55 WETZEL DRIVE, SUITE 2 HANOVER, PA 17331 | FEDERAL INSURANCE COMPANY | $0 | — | $0 | 0.00% |
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 | 1,043 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 52 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,095 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 629 | $0 |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,099 | $163K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 206 | $71K |
| Other | FEDERAL INSURANCE COMPANY | 173 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,099 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.