| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE COALITION3 | 417 WALNUT STREET HARRISBURG, PA 17101 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $210 | $0 | $210 | 9.07% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE INC | 417 WALNUT STREET HARRISBURG, PA 17101 | DEARBORN LIFE INSURANCE COMPANY | $86 | $0 | $86 | 16.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCI INSURANCE AGENCY BROKER | Insurance agents and brokers Service code 22 | 417 WALNUT STREET HARRISBURG, PA 17101 | $2K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $1K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $291 |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | -$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 | 17 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 18 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CAPITAL ADVANTAGE ASSURANCE COMPANY | 16 | $2K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 16 | $2K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 28 | $533 |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 18 | $21K |
| Other | DEARBORN LIFE INSURANCE COMPANY | 28 | $533 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 28 | — |
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.