| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLS | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | DELTA DENTAL OF PENNSYLVANIA | $2K | $0 | $2K | 5.24% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $427 | $4K | 17.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $1K | $4K | 24.79% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $253 | $2K | 17.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $764 | $3K | 21.16% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $235 | $2K | 16.99% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $1K | $2K | 28.30% |
| TRIBEN INSURANCE SOLUTIONS INC Filed as: TRIBEN INSURNACE SOLUTIONS INC | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $469 | $0 | $469 | 10.66% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTIONS | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $11 | $0 | $11 | 0.25% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $314 | $0 | $314 | 10.72% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTIONS | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $60 | $0 | $60 | 2.05% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $293 | $0 | $293 | 11.39% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $149 | $0 | $149 | 7.06% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTIONS | 24 E 2ND ST MEDIA, PA 19063 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $26 | $0 | $26 | 1.23% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURNACE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $124 | $17 | $141 | 17.05% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTION | 24 E 2ND ST 1ST FL MEDIA, PA 19063 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $72 | $81 | $153 | 24.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GREAT WEST HEALTHCARE/ CIGNA EIN 84-0467907 NONE | Direct payment from the plan; Named fiduciary; Participant communication; Other services; Non-monetary compensation; Claims processing; Float revenue; Contract Administrator Service code 12 | — | $51K |
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 NONE | Contract Administrator; Claims processing Service code 12 | — | $23K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Other fees; Other services; Consulting (general) Service code 16 | — | $8K |
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 | 141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 96 | $416K |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 166 | $45K |
| Vision | VISION BENEFITS OF AMERICA | 94 | $10K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 133 | $24K |
| Short-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 50 | $36K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 44 | $21K |
| Stop-loss / reinsurancereinsurance | AMERICAN FIDELITY ASSURANCE COMPANY | 96 | $404K |
| Other(8 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 133 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 166 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.