| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENGLE-HAMBRIGHT & DAVIES, INC.3 Filed as: ENGLE-HAMBRIGHT & DAVIES | 1857 WILLIAM PENN WAY LANCASTER, PA 17605 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 11.39% |
| INDEPENDENCE PLANNING GROUP3 | 1767 SENTRY PKWY W BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11 | $0 | $11 | 0.06% |
| ENGLE-HAMBRIGHT & DAVIES, INC.3 Filed as: ENGLE-HAMBRIGHT & DAVIES | 1857 WILLIAM PENN WAY LANCASTER, PA 17601 | DELTA DENTAL OF PENNSYLVANIA | $1K | $0 | $1K | 10.00% |
| ENGLE-HAMBRIGHT & DAVIES, INC.3 Filed as: ENGLE HAMBRIGHT & DAVIES INC | 1857 WILLIAM PENN WAY LANCASTER, PA 17601 | AMERITAS LIFE INSURANCE CORP | $104 | $0 | $104 | 5.71% |
| YOUNG, IAN, S3 | 145 WOODHILL RD FLEETWOOD, PA 19522 | AMERITAS LIFE INSURANCE CORP | $78 | $0 | $78 | 4.29% |
| IBSI HOLDINGS INC3 Filed as: IBSI HOLDINGS, INC | P.O. BOX 24337 WINSTON SALEM, NC 27114 | AMERITAS LIFE INSURANCE CORP | $55 | $0 | $55 | 3.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ENGLE HAMBRIGHT & DAVIES BROKER | Insurance agents and brokers Service code 22 | 1857 WILLIAM PENN WAY LANCASTER, PA 17601 | $13K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $12K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $9K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $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 | 32 | 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) | 32 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 20 | $14K |
| Vision | AMERITAS LIFE INSURANCE CORP | 22 | $2K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 35 | $20K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 35 | $20K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 32 | $96K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 35 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 35 | — |
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.