| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALPHA BENEFITS GROUP INC3 | 125 EAST ELM ST STE 210 CONSHOHOCKEN, PA 19428 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 8.88% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES IN | — | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $547 | $547 | 3.02% |
| FINANCIAL BALANCE GROUP LLC3 | — | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16 | $0 | $16 | 0.09% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF PA | — | MADISON NATIONAL LIFE INSURANCE CO. | $408 | $0 | $408 | 10.75% |
| NORTH AMERICAN BENEFITS COMPANY5 Filed as: NORTH AMERICAN BENEFITS CO | — | MADISON NATIONAL LIFE INSURANCE CO. | $256 | $0 | $256 | 6.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BROWN & BROWN (PA) EIN 20-0878127 BROKER | Insurance agents and brokers Service code 22 | — | $9K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $8K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
| CAPITAL BLUECROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | -$7K |
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 | 25 | 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) | 25 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 22 | $18K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $0 |
| Short-term disability | MADISON NATIONAL LIFE INSURANCE CO. | 8 | $4K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 25 | $90K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 25 | — |
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.