| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROBLEM SOLVERS INC3 | 17 EAST PHILADELPHIA AVE P.O. BOX 584 BOYERTOWN, PA 19512 | MADISON NATIONAL LIFE INSURANCE COMPANY | $749 | $0 | $749 | 12.01% |
| NORTH AMERICAN BENEFITS COMPANY3 | 20 VALLEY STREAM PARKWAY STE 310 MALVERN, PA 19355 | MADISON NATIONAL LIFE INSURANCE COMPANY | $0 | $531 | $531 | 8.51% |
| EMERSON REID LLC3 | 1305 WALT WHITMON RD STE 310 MELVILLE, NY 11747 | MADISON NATIONAL LIFE INSURANCE COMPANY | $0 | $312 | $312 | 5.00% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $506 | $0 | $506 | 9.80% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | DAVIS VISION | $718 | $0 | $718 | 20.11% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | THE GUARDIAN LIFE INSURANCE COMPANY | $835 | $0 | $835 | 26.39% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | DEARBORN LIFE INSURANCE COMPANY | $391 | $0 | $391 | 37.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCI INSURANCE AGENCY EIN 25-1784573 BROKER | Insurance agents and brokers Service code 22 | — | $10K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN. | Claims processing Service code 12 | — | $7K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $6K |
| CONNECTCARE 3 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 | 26 | 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) | 27 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 10 | $5K |
| Vision | DAVIS VISION | 26 | $4K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 26 | $1K |
| Short-term disability | MADISON NATIONAL LIFE INSURANCE COMPANY | 26 | $6K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 25 | $166K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY | 9 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 26 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.