| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIRST NIAGARA RISK MANAGEMENT3 Filed as: FIRST NIAGARA RISK MANAGEMENT INC | 1215 MANOR DR STE 200 MECHANICSBURG, PA 17055 | AETNA LIFE INSURANCE COMPANY | $16K | — | $16K | 3.55% |
| FIRST NIAGARA RISK MANAGEMENT3 Filed as: FIRST NIAGARA RISK MANAGEMENT INC | 1215 MANOR DR STE 200 MECHANICSBURG, PA 17055 | HARTFORD LIFE AND ACCIDENT | $11K | — | $11K | 4.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEYSTONE HEALTH PLAN CENTRAL EIN 23-2399845 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 2500 ELMERTON AVE HARRISBURG, PA 17177 | $2.1M |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $785K |
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 2500 ELMERTON AVE HARRISBURG, PA 17177 | $491K |
| UNITED CONCORDIA COMPANIES INC EIN 25-1687586 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 4401 DEER PATH ROAD HARRISBURG, PA 17110 | $210K |
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 | 8,218 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 314 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 8,532 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AETNA LIFE INSURANCE COMPANY | 8,562 | $460K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 881 | $222K |
| Other | AETNA LIFE INSURANCE COMPANY | 8,562 | $460K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,562 | — |
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.