| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 | 772 LITITZ PIKE LITITZ, PA 17543 | THE GUARDIAN LIFE INSRUANCE COMPANY OF AMERICA | $260 | $0 | $260 | 10.01% |
| LIAZON BENEFITS INC3 | 199 SCOTT ST 8TH FLOOR BUFFALO, NY 12982 | THE GUARDIAN LIFE INSRUANCE COMPANY OF AMERICA | $130 | $0 | $130 | 5.01% |
| INDEPENDENCE PLANNING GROUP3 | 1767 SENTRY PKWY W BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSRUANCE COMPANY OF AMERICA | $3 | $0 | $3 | 0.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AP BENEFIT ADVISORS, LLC BROKER | Insurance agents and brokers Service code 22 | 280 GRANITE RUN DRIVE SUITE 250 LANCASTER, PA 17601 | $7K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $7K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $5K |
| CONNECTCARE 3 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 | 31 | 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) | 31 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Vision | THE GUARDIAN LIFE INSRUANCE COMPANY OF AMERICA | 15 | $3K |
| 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 | EVEREST REINSURANCE COMPANY | 27 | $107K |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 27 | — |
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.