| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENJAMIN R MORLEY3 | 5311 WHEATLAND DR ZIONSVILLE, PA 18092 | AFLAC | $304 | $0 | $304 | 3.57% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 645 HAMILTON ST STE 1002 ALLENTOWN, PA 18101 | AFLAC | $201 | $0 | $201 | 2.36% |
| AARON GEISER3 Filed as: AARON J GEISER | 1754 RED BUD RD QUAKERTOWN, PA 18951 | AFLAC | $119 | $0 | $119 | 1.40% |
| THOMAS B DAVIS3 | 835 ROSEHILL DR KING OF PRUSSIA, PA 19406 | AFLAC | $78 | $0 | $78 | 0.92% |
| STEPHEN C SIBEL3 | 86 MAPLE AVE COLLEGEVILLE, PA 19426 | AFLAC | $70 | $0 | $70 | 0.82% |
| ANDREW J JUNIKIEWICZ JR3 | 22 BROOK HOLLOW DR SINKING SPRING, PA 19608 | AFLAC | $41 | $0 | $41 | 0.48% |
| ACRISURE LLC3 Filed as: ACRISURE WALLSTREET PARTNERS LLC | 158 PRINTERS LN NEW LONDON, NC 28127 | AFLAC | $36 | $0 | $36 | 0.42% |
| SVETLANA ZEITLIN3 | 105 ADDIS DR CHURCHVILLE, PA 18966 | AFLAC | $27 | $0 | $27 | 0.32% |
| MICHELE L BOGRETTE3 Filed as: MICHELE L BORGETTE | 109 BELLE VISTA CT WINSTON SALEM, NC 27106 | AFLAC | $18 | $0 | $18 | 0.21% |
| EDWARD F MROWKA JR3 | 5106 TIMBER LN SCHNECKSVILLE, PA 18078 | AFLAC | $17 | $0 | $17 | 0.20% |
| TONY J DELBEN3 | 143 SANDREED DR MOORESVILLE, NC 28117 | AFLAC | $15 | $0 | $15 | 0.18% |
| JOSE A SCHIENEMAN3 | 1881 S CARRIAGE LN CHANDLER, AZ 85286 | AFLAC | $11 | $0 | $11 | 0.13% |
| MATTHEW G BERGER3 | 10 UNION AVE APT 302 BALA CYNWYD, PA 19004 | AFLAC | $10 | $0 | $10 | 0.12% |
| CONLON AND ASSOCIATES LLC3 | PO BOX 402 BRIDGEPORT, PA 19405 | AFLAC | $9 | $0 | $9 | 0.11% |
| JACQUELINE M EBERZ3 | 98 LAMP POST RD NEW BRITAIN, PA 18901 | AFLAC | $8 | $0 | $8 | 0.09% |
| ERIC R MACDOUGALL3 Filed as: ERIC MACDOUGALL & ASSOC INC | 5904 MARGARETS WAY NEW HOPE, PA 18938 | AFLAC | $8 | $0 | $8 | 0.09% |
| SEAN G HIGGINS3 | 1405 LARKSPUR LN MALVERN, PA 19355 | AFLAC | $6 | $0 | $6 | 0.07% |
| DEBORAH S GOLDEN3 Filed as: DEBORAH L POPPERT | 1167 W BALTIMORE PIKE 239 MEDIA, PA 19063 | AFLAC | $5 | $0 | $5 | 0.06% |
| STUART C WEBBER3 | 203 TANGLEWOOD DR LEWES, DE 19958 | AFLAC | $4 | $0 | $4 | 0.05% |
| LAURIE L SMITH3 | 577 TRUESDALE HILL RD LAKE GEORGE, NY 12845 | AFLAC | $1 | $0 | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MCGRIFF INSURANCE SERVICES (FORMERL EIN 56-1623293 BROKER | Insurance agents and brokers Service code 22 | — | $15K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $12K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
| HIGHMARK BLUE SHIELD (SEPA) ADMIN | Claims processing Service code 12 | 120 FIFTH AVE PITTSBURGH, PA 15222 | -$515 |
| HIGHMARK BLUE SHIELD (CENTRAL) EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | -$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 | 34 | 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) | 34 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 34 | $130K |
| Other(2 contracts, 2 carriers) | AFLAC | 9 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 34 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.