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| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERRILL LYNCH WEALTH MANAGEMENT EIN 13-5674085 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | ONE BETHLEHEM PLAZA BETHLEHEM, PA 18018 | $16K |
| JACOBY DONNOR PC EIN 23-2220388 NONE | Legal; Direct payment from the plan Service code 29 | 1700 MARKET STREET PHILADELPHIA, PA 19103 | $15K |
| CHARLES W JOHNSTON PC NONE | Legal; Direct payment from the plan Service code 29 | 101 ERFORD ROAD CAMP HILL, PA 17001 | $11K |
| JENNINGS SIGMOND, PC EIN 23-2025670 NONE | Legal; Direct payment from the plan Service code 29 | 1835 MARKET STREET PHILADELPHIA, PA 19103 | $6K |
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 | 357 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 123 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 480 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAPITAL ADVANTAGE ASSURANCE COMPANY | 497 | $250K |
| Dental | UNITED CONCORDIA COMPANIES INC | 480 | $24K |
| Vision | HIGHMARK LIFE INSURANCE COMPANY | 190 | $56K |
| Life insurance | FORT DEARBORN LIFE INSURANCE COMPANY | 357 | $105K |
| Short-term disability | FORT DEARBORN LIFE INSURANCE COMPANY | 357 | $105K |
| Stop-loss / reinsurancereinsurance | AVALON INSURANCE COMPANY | 497 | $341K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 497 | — |
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.