| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $1K | $0 | $1K | 10.05% |
| PROBLEM SOLVERS INC3 | — | MADISON NATIONAL LIFE INSURANCE COMPANY | $490 | $0 | $490 | 12.01% |
| NORTH AMERICAN BENEFITS COMPANY5 | 20 VALLEY STREAM PKWY MALVERN, PA 19355 | MADISON NATIONAL LIFE INSURANCE COMPANY | $0 | $388 | $388 | 9.51% |
| EMERSON REID LLC3 | 4507 N FRONT ST, #301 HARRISBURG, PA 17110 | MADISON NATIONAL LIFE INSURANCE COMPANY | $0 | $204 | $204 | 5.00% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $356 | $0 | $356 | 9.88% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | DAVIS VISION | $473 | $0 | $473 | 19.57% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | THE GUARDIAN LIFE INSURANCE COMPANY | $531 | $0 | $531 | 24.40% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC | 417 WALNUT ST HARRISBURG, PA 17101 | THE GUARDIAN LIFE INSURANCE COMPANY | $114 | $0 | $114 | 7.98% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | DEARBORN LIFE INSURANCE COMPANY | $369 | $0 | $369 | 27.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCI (PA CHAMBER INSURANCE) EIN 25-1784573 BROKER | Insurance agents and brokers Service code 22 | — | $7K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $4K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $1K |
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 | 25 | 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) | 25 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 8 | $15K |
| Vision | DAVIS VISION | 13 | $2K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 25 | $1K |
| Short-term disability | MADISON NATIONAL LIFE INSURANCE COMPANY | 15 | $4K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 13 | $152K |
| Other(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY | 4 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 25 | — |
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.