| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 | 200 INTERNATIONAL CIR STE 4500 HUNT VALLEY, MD 21031 | UNITED CONCORDIA INSURANCE COMPANY | $616 | $437 | $1K | 8.69% |
| AP BENEFIT ADVISORS, LLC3 | 200 INTERNATIONAL CIR STE 4500 HUNT VALLEY, MD 21031 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $830 | $0 | $830 | 20.88% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS CAPITAL | 772 LITITZ PIKE LITITZ, PA 17543 | NATIONAL VISION ADMINISTRATORS, L.L.C. | $116 | $0 | $116 | 5.02% |
| AP BENEFIT ADVISORS, LLC3 | 200 INTERNATIONAL CIR STE 4500 HUNT VALLEY, MD 21031 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $201 | $0 | $201 | 15.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSURED PARTNERS (CENTRAL PA) EIN 30-0837157 BROKER | Insurance agents and brokers Service code 22 | 772 LITITZ PIKE LITITZ, PA 17543 | $9K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $4K |
| ASSURED PARTNERS BROKER | Insurance agents and brokers Service code 22 | 23452 HWY 80 E STATESBORO, GA 30461 | $2K |
| CONNECTCARE3, LLC EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $1K |
| HIGHMARK EIN 23-1294723 CARRIER | Claims processing Service code 12 | — | $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 | 82 | 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) | 83 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 57 | $12K |
| Vision | NATIONAL VISION ADMINISTRATORS, L.L.C. | 55 | $2K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 86 | $5K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 86 | $5K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 65 | $59K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 86 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 86 | — |
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.