| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BLUE CROSS | PO BOX 779516 HARRISBURG, PA 171779516 | HIGHMARK BLUE SHIELD | — | — | $0 | 0.00% |
| BENEFIT MANAGEMENT, INC.3 Filed as: BENEFIT MANAGEMENT GROUP INC | 10 N DORCUS STREET LEWISTOWN, PA 17044 | UNION SECURITY INSURANCE COMPANY | $3K | — | $3K | 10.01% |
| ERC OF NEW YORK3 | 1305 WALT WHITMAN ROAD MELVILLE, NY 11747 | UNION SECURITY INSURANCE COMPANY | — | $851 | $851 | 3.00% |
| AMERICAN HERITAGE LIFE INSURANCE CO | PO BOX 650514 DALLAS, TX 752650514 | AMERICAN HERITAGE LIFE | — | — | $0 | 0.00% |
| FIDELITY SECURITY LIFE INSURANCE/EY | PO BOX 632530 CINCINATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE/EYEMED | — | — | $0 | 0.00% |
No Schedule C service providers reported on this filing.
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 | 54 | 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) | 54 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK BLUE SHIELD | 55 | $752K |
| Dental | UNION SECURITY INSURANCE COMPANY | 44 | $28K |
| Vision | FIDELITY SECURITY LIFE INSURANCE/EYEMED | 48 | $8K |
| Life insurance | AMERICAN HERITAGE LIFE | 16 | $17K |
| Short-term disability | AMERICAN HERITAGE LIFE | 16 | $17K |
| Other | AMERICAN HERITAGE LIFE | 16 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 55 | — |
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.