| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $98 | $98 | 0.06% |
| MCCONKEY BENEFITS & FINANCIAL SERV3 | 2555 KINGSTON ROAD SUITE 100 YORK, PA 17402 | DELTA DENTAL OF PENNSYLVANIA | $7K | $0 | $7K | 5.00% |
| JOSEPH DECEORCE3 | 7736 HAMILTON BLVD #2 BREINIGSVILLE, PA 18031 | AFLAC | $447 | $31 | $478 | 4.67% |
| JAMES A RUSH3 Filed as: JAMES RUSH | 1822 FAIRVIEW AVE EASTON, PA 19042 | AFLAC | $354 | $55 | $409 | 4.00% |
| EDWARD F MROWKA JR3 Filed as: EDWARD MROWKA JR | 5106 TIMBER LANE SCHNECKSVILLE, PA 18078 | AFLAC | $270 | $22 | $292 | 2.85% |
| STEPHEN BRETZ3 | 7950 TANGLEWOOD DRIVE NEW PORT RICHEY, FL 34654 | AFLAC | $254 | $0 | $254 | 2.48% |
| JANE N ARTMAN3 Filed as: JANE ARTMAN | 75 ARTMAN AVE HELLAM, PA 17406 | AFLAC | $185 | $0 | $185 | 1.81% |
| JACQUELINE EBERZ3 | 1919 LIBERTY LANE SUITE 310 ALLENTOWN, PA 18106 | AFLAC | $118 | $22 | $140 | 1.37% |
| TODD E SHENBERGER3 Filed as: TODD SHENBERGER | 3620 WYOMING BLVD NE SUITE 102G ALBUQUERQUE, NM 87111 | AFLAC | $120 | $0 | $120 | 1.17% |
| BARRY E DRASHER3 | 320 LEHIGH ST WHITE HAVEN, PA 18661 | AFLAC | $84 | $0 | $84 | 0.82% |
| LISA A PERRI3 Filed as: LISA PERRY | 1650 SAND LAKE ROAD SUITE 201D ORLANDO, FL 32809 | AFLAC | $61 | $0 | $61 | 0.60% |
| MARILYN BRANNEN3 | 648 GOLDENVILLE ROAD GETTYSBURG, PA 17325 | AFLAC | $57 | $0 | $57 | 0.56% |
| WILSON H TRANSUE3 Filed as: WILSON TRANSUE | 1487 SULLIVAN TRL TANNERSVILLE, PA 18372 | AFLAC | $54 | $0 | $54 | 0.53% |
| WILLIAM M KNOTT3 Filed as: WILLIAM KNOTT | 24040 GREEN GARDENS CT EUSTIS, FL 32736 | AFLAC | $37 | $0 | $37 | 0.36% |
| LARRY MYERS3 | 8944 N TRAVIS DR CITRUS SPRINGS, FL 34434 | AFLAC | $34 | $0 | $34 | 0.33% |
| JASON E FERGER3 Filed as: JASON FERGER | 3706 EAGLEWOOD ST VALRICO, FL 33596 | AFLAC | $30 | $0 | $30 | 0.29% |
| FAITH CRYSTAL TAYLOR3 Filed as: FAITH BURRIS | 251 LONG BEACH DR HOT SPRINGS, AR 71913 | AFLAC | $28 | $0 | $28 | 0.27% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $27 | $0 | $27 | 0.26% |
| RPM LTD3 | PO BOX 484 BLOOMINGDALE, CA 31302 | AFLAC | $21 | $0 | $21 | 0.21% |
| KYMBERLY G KNOTT3 Filed as: KYMBERLY KNOTT | 2404 GREEN GARDENS CT EUSTIS, FL 32736 | AFLAC | $19 | $0 | $19 | 0.19% |
| RANDALL SIMS3 | 138 DERR DR COLLEGEVILLE, PA 19426 | AFLAC | $16 | $0 | $16 | 0.16% |
| CAROL A MROWKA3 Filed as: CAROL MROWKA | 5106 TIMBER LANE SCHNECKSVILLE, PA 18070 | AFLAC | $14 | $0 | $14 | 0.14% |
| KEYSTONE PACESETTERS INC3 | 100 SPRING HARBOR DRIVE #565 COLUMBUS, GA 31904 | AFLAC | $11 | $0 | $11 | 0.11% |
| DIANNE L MARTIN3 Filed as: DIANNE MARTIN | 125 MANOR STREET HARRISBURG, PA 17110 | AFLAC | $9 | $0 | $9 | 0.09% |
| MARY ELLEN BELL GRETH3 Filed as: MARY ELLEN GRETH | 1807 READING BLVD WYOMISSING, PA 19610 | AFLAC | $7 | $0 | $7 | 0.07% |
| JAMES BROOKS3 | 1253 WEST LEESPORT ROAD LEESPORT, PA 19533 | AFLAC | $7 | $0 | $7 | 0.07% |
| LARRY L NEWMAN3 | PO BOX 785 SUNBURY, PA 17801 | AFLAC | $6 | $0 | $6 | 0.06% |
| HARRY D WAGNER3 Filed as: HARRY WAGNER | PO BOX 7247 AUDOBON, PA 19407 | AFLAC | $6 | $0 | $6 | 0.06% |
| JOHN B LACARIA3 Filed as: JOHN LACARIA | 102 JENNIFER LN BRIDGEPORT, WV 26330 | AFLAC | $5 | $0 | $5 | 0.05% |
| HARRY S GOOD3 | PO BOX 175 LOGANVILLE, PA 17342 | AFLAC | $5 | $0 | $5 | 0.05% |
| DANIEL R JUDY3 Filed as: DANIEL JUDY | 231 WALTERS MILL RD SOMERSET, PA 15501 | AFLAC | $2 | $0 | $2 | 0.02% |
| MARK D BARBIER3 Filed as: MARK BARBIER | 800 DEER TRAIL LANE OAK BROOK, IL 60523 | AFLAC | $1 | $0 | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH AMERICA EIN 62-1411933 ADMIN | Claims processing Service code 12 | — | $115K |
| MCCONKEY BENEFITS & FINANCIAL SERV EIN 23-3086396 BROKER | Insurance agents and brokers Service code 22 | — | $63K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $25K |
| BENEFIT COORDINATOR CORPORATION EIN 25-1453488 FSA ADMIN | Claims processing Service code 12 | — | $7K |
| BENEFITMALL ADMIN | Claims processing Service code 12 | 501 FAIRMONT AVENUE SUITE 400 TOWSON, MD 21286 | $5K |
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 | 292 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 550 | $149K |
| Vision | NATIONAL VISION ADMINISTRATORS - HEARTLAND | 506 | $21K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 292 | $162K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 292 | $162K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 292 | $162K |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 292 | $178K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 550 | — |
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.