| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FABRICANT & FABRICANT3 | 1251 OLD NORTHERN BLVD ROSLYN, NY 11576 | SUN LIFE ASSURANCE COMPANY OF CANADA | $16K | — | $16K | 4.00% |
| ALAN KIFFERSTEIN3 | 570 LEXINGTON AVE NEW YORK, NY 10022 | SUN LIFE ASSURANCE COMPANY OF CANADA | $16K | — | $16K | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHAMERICA OF PENNSYLVANIA INC EIN 25-1264318 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $2.0M |
| MULTIPLAN INC EIN 13-3068979 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $264K |
| BASYS, INC. EIN 52-1796473 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $254K |
| STEVENS & LEE PC EIN 23-1886296 NONE | Legal; Direct payment from the plan Service code 29 | — | $227K |
| DELTA DENTAL OF PENNSYLVANIA EIN 23-1667011 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $226K |
| GENERAL PRESCRIPTION PROGRAMS, INC. EIN 13-3271051 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $219K |
| WILLIG, WILLIAMS & DAVIDSON EIN 23-2416488 NONE | Legal; Direct payment from the plan Service code 29 | — | $209K |
| MORGAN, LEWIS & BOCKIUS, LLP EIN 23-0891050 NONE | Legal; Direct payment from the plan Service code 29 | — | $146K |
| LOU ANN DELONG EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $129K |
| JOSEPH SAMOLEWICZ EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $121K |
| CHERIE MIERZEJEWSKI EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $116K |
| SEI INVESTMENTS EIN 23-1707341 NONE | Investment management fees paid indirectly by plan; Investment management fees paid directly by plan Service code 51 | — | $109K |
| BEYER-BARBER COMPANY EIN 23-2503024 NONE | Actuarial; Consulting (general); Direct payment from the plan Service code 11 | — | $109K |
| DAPHNE ROSSI EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $106K |
| BELINDA STOUDT EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $104K |
| JENNA SMITH EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $103K |
| ARISTEA MALDANADO EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $100K |
| TRICIA MOODY EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $99K |
| APRIL MAISONET EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $99K |
| KIM FISCHER EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $98K |
| NINA KISTLER EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $98K |
| MARTIN CULLEN EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $98K |
| CAROL ZIMMERMAN EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $98K |
| DEANN BRANDT EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $97K |
| JOY DREXEL EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $96K |
| MARICA MOYER EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $94K |
| GARY NOLL EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $93K |
| CYNTHIA BUTINCU EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $89K |
| JAMES STRICKER EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $86K |
| JOANN VOGEL EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $85K |
| STACIE MARKS EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $82K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $81K |
| SUSAN BRICKER EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $76K |
| CONSILIUM LLC EIN 46-1828993 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $76K |
| KEVIN MCTISH EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $75K |
| JUDITH STRICKER EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $70K |
| RUSTY KEMP EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $67K |
| ROBERT GENSLINGER EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $66K |
| CHERYL BURKE EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $61K |
| DEVON HEALTH SERVICES INC. EIN 23-2743471 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $59K |
| LORI KEMMERER EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $59K |
| WEIDENHAMMER SYSTEMS CORP EIN 23-2054990 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $53K |
| DEBRA PFENNIG EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $53K |
| LUANN WOLFE EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $52K |
| DAVIS VISION INC EIN 11-3051991 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $52K |
| CHRISTINA BYRNE EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $50K |
| CHRISTINA RIVERA EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $50K |
| KELLY SNYDER EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $48K |
| LYNN ROTHENBERGER EIN 23-6262789 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $47K |
| RICHARD PASTUSZEK EIN 23-6262789 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $47K |
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 | 5,459 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 888 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 6,347 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 8,098 | $399K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 8,098 | $399K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,098 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.