| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: SIMKISS AGENCY INC. | PO BOX 1787 PAOLI, PA 19301 | HARTFORD LIFE AND ACCIDENT | $4K | $0 | $4K | 10.25% |
| CORPORATE SYNERGIES GROUP LLC3 | 5000 DEARBORN CIRCLE, SUITE 100 MT. LAUREL, NJ 08054 | UNITED CONCORDIA INSURANCE COMPANY | $2K | $0 | $2K | 9.89% |
| CORPORATE SYNERGIES GROUP LLC3 | 5000 DEARBORN CIRCLE, SUITE 100 MT. LAUREL, NJ 08054 | UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. | $1K | $0 | $1K | 10.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INDEPENDENCE ADMINISTRATORS EIN 23-2184623 ADMIN | Claims processing Service code 12 | — | $28K |
| CORPORATE SYNERGIES GROUP, LLC BROKER | Insurance agents and brokers Service code 22 | 5000 DEARBORN CIR, SUITE 100 MOUNT LAUREL, NJ 08054 | $14K |
| THE BENECON GROUP, INC. EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $9K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $3K |
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 | 60 | 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) | 60 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 77 | $31K |
| Vision | VISION SERVICE PLAN | 0 | $0 |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 60 | $38K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 53 | $207K |
| Other | HARTFORD LIFE AND ACCIDENT | 60 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 77 | — |
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.