| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STRICKLER AGENCY, INC3 | 1200 E MCKINLEY ST CHAMBERSBURG, PA 17201 | DEARBORN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.09% |
| THE BENECON GROUP3 | 201 E OREGON RD STE 100 LITITZ, PA 17543 | UNITED CONCORDIA INSURANCE COMPANY | $1K | $0 | $1K | 6.75% |
| ERC OF NY, INC.3 | 1499 3RD AVE NEW YORK, NY 10118 | UNITED CONCORDIA INSURANCE COMPANY | $498 | $0 | $498 | 3.33% |
| STRICKLER AGENCY, INC3 | 1200 E MCKINLEY ST CHAMBERSBURG, PA 17201 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $74 | $0 | $74 | 3.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $12K |
| STRICKLER AGENCY, INC. BROKER | Insurance agents and brokers Service code 22 | 1200 E MCKINLEY ST CHAMBERSBURG, PA 17201 | $10K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $8K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
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 | 32 | 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) | 33 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 36 | $15K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 31 | $2K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 38 | $23K |
| Short-term disability | DEARBORN LIFE INSURANCE COMPANY | 38 | $23K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 38 | $23K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 32 | $85K |
| Other | DEARBORN LIFE INSURANCE COMPANY | 38 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 38 | — |
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.