| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA & ASSOCIATES LLC | 4233 PABLO PROFESSIONAL COURT STE 2 JACKSONVILLE, FL 32224 | GEISINGER QUALITY OPTIONS, INC. | $20K | $0 | $20K | 3.00% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 4233 PABLO PROFESSIONAL COURT STE 2 JACKSONVILLE, FL 32224 | UNION SECURITY INSURANCE COMPANY | $4K | — | $4K | 9.22% |
| C3 GROUP, LLC3 | PO BOX 554 CLARKS SUMMIT, PA 18411 | UNION SECURITY INSURANCE COMPANY | $319 | — | $319 | 0.84% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 4233 PABLO PROFESSIONAL CT. STE 200 JACKSONVILLE, PA 32224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 16.51% |
| C3 GROUP, LLC3 | PO BOX 554 CLARKS SUMMIT, PA 18411 | SUN LIFE ASSURANCE COMPANY OF CANADA | $172 | — | $172 | 1.17% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 4233 PABLO PROFESSIONAL CT STE 200 JACKSONVILLE, PA 32224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 16.40% |
| C3 GROUP, LLC3 | PO BOX 554 CLARKS SUMMIT, PA 18411 | SUN LIFE ASSURANCE COMPANY OF CANADA | $166 | — | $166 | 1.23% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 4233 PABLO PROFESSIONAL CT. STE 200 JACKSONVILLE, PA 32224 | UNION SECURITY INSURANCE COMPANY | $959 | — | $959 | 9.15% |
| C3 GROUP, LLC3 | PO BOX 554 CLARKS SUMMIT, PA 18411 | UNION SECURITY INSURANCE COMPANY | $89 | — | $89 | 0.85% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 4233 PABLO PROFESSIONAL CT. STE 200 JACKSONVILLE, FL 32224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 16.77% |
| C3 GROUP, LLC3 | PO BOX 554 CLARKS SUMMIT, PA 18411 | SUN LIFE ASSURANCE COMPANY OF CANADA | $127 | — | $127 | 1.23% |
| MONTOYA AND ASSOCIATES LLC3 Filed as: MONTOYA AND ASSOCIATES, LLC | 4233 PABLO PROFESSIONAL CT STE 200 JACKSONVOLLE, FL 32224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 16.40% |
| C3 GROUP, LLC3 | PO BOX 554 CLARKS SUMMIT, PA 18411 | SUN LIFE ASSURANCE COMPANY OF CANADA | $68 | — | $68 | 0.90% |
No Schedule C service providers reported on this filing.
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GEISINGER QUALITY OPTIONS, INC. | 135 | $672K |
| Dental | UNION SECURITY INSURANCE COMPANY | 81 | $38K |
| Vision | UNION SECURITY INSURANCE COMPANY | 76 | $10K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 113 | $8K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 52 | $15K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 37 | $13K |
| Prescription drug | GEISINGER QUALITY OPTIONS, INC. | 135 | $672K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 52 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.