| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS SER OF THE WEST/DBA THE PET | PO BOX 249 MONTGOMERYVILLE, PA 18936 | DELTA DENTAL | $537 | $0 | $537 | 10.21% |
| PCF INSURANCE SERVICES OF THE WEST3 | 105 MONTGOMERY AVENUE SUITE 2051 MONTGOMERYVILLE, PA 18936 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $179 | $0 | $179 | 11.00% |
| PCF INSURANCE SERVICES OF THE WEST3 | 105 MONTGOMERY AVENUE SUITE 2051 MONTGOMERYVILLE, PA 18936 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $179 | $0 | $179 | 11.02% |
| MACNEAL, MICHAEL N3 | PO BOX 249 MONTGOMERYVILLE, PA 18936 | HIGHMARK BLUE SHIELD (CENTRAL) | $40 | $0 | $40 | 3.97% |
| THE BENECON GROUP3 Filed as: THE BENECON GROUP, LLC | PO BOX 5406 LANCASTER, PA 17606 | HIGHMARK BLUE SHIELD (CENTRAL) | $20 | $0 | $20 | 1.98% |
| PCF INSURANCE SERVICES OF THE WEST3 | 105 MONTGOMERY AVENUE SUITE 2051 MONTGOMERYVILLE, PA 18936 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $124 | $0 | $124 | 15.05% |
| PCF INSURANCE SERVICES OF THE WEST3 | 105 MONTGOMERY AVENUE SUITE 2051 MONTGOMERYVILLE, PA 18936 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $17 | $0 | $17 | 15.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST, EIN 82-1368960 BROKER | Insurance agents and brokers Service code 22 | — | $4K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $3K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $562 |
| HIGHMARK BLUE SHIELD (CENTRAL) EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $308 |
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 | 48 | 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) | 48 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 38 | $5K |
| Vision | HIGHMARK BLUE SHIELD (CENTRAL) | 70 | $1K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 48 | $2K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 48 | $2K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 48 | $824 |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 31 | $40K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 48 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 70 | — |
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.