| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CREATIVE BENEFITS, INC.3 | 3809 WEST CHESTER PIKE SUITE 190 NEWTOWN SQUARE, PA 19073 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $8K | $11K | 7.25% |
| CREATIVE BENEFITS, INC.3 | 3809 WEST CHESTER PIKE SUITE 190 NEWTOWN SQUARE, PA 19073 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $6K | 7.28% |
| CREATIVE BENEFITS, INC.3 | 3809 WEST CHESTER PIKE SUITE 190 NEWTOWN SQUARE, PA 19073 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $2K | $7K | 9.36% |
| CREATIVE BENEFITS, INC.3 | 3809 WEST CHESTER PIKE SUITE 190 NEWTOWN SQUARE, PA 19073 | VISION BENEFITS OF AMERICA | $2K | — | $2K | 10.00% |
| CREATIVE BENEFITS, INC.3 | 3809 WEST CHESTER PIKE SUITE 190 NEWTOWN SQUARE, PA 19073 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $249 | $2K | 16.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHSMART BENEFIT SOLUTIONS INC EIN 36-4099199 CLAIMS ADMIN | Claims processing Service code 12 | — | $57K |
| CREATIVE BENEFITS, INC. EIN 23-2245507 BROKER | Consulting (general); Insurance agents and brokers; Insurance brokerage commissions and fees Service code 16 | — | $54K |
| HS CARE MANAGEMENT EIN 75-2960859 ADMIN | Claims processing Service code 12 | — | $5K |
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 | 356 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 356 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $158K |
| Vision | VISION BENEFITS OF AMERICA | 185 | $21K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 326 | $81K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 356 | $70K |
| Stop-loss / reinsurancereinsurance | U.S. FIRE INSURANCE | 169 | $633K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 326 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 356 | — |
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.