| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEVIN KOZIOL3 | 60 CHESTNUT TREE ROAD NOXEN, PA 18636 | CITIZENS SECURITY LIFE INSURANCE COMPANY | $20K | $0 | $20K | 63.31% |
| KEVIN KOZIOL3 | 60 CHESTNUT TREE ROAD NOXEN, PA 18636 | AMERICAN UNITED LIFE INSURANCE COMPANY | $3K | $0 | $3K | 11.29% |
| URL INC3 | 500 NATIONWIDE DR HARRISBURG, PA 17110 | AMERICAN UNITED LIFE INSURANCE COMPANY | $0 | $1K | $1K | 4.00% |
| KEVIN KOZIOL3 | 60 CHESTNUT TREE ROAD NOXEN, PA 18636 | VISION BENEFITS OF AMERICA | $838 | $0 | $838 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $61K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $24K |
| GENESIS ASSET PROTECTION BROKER | Insurance agents and brokers Service code 22 | 115 W COURT STREET DOYLESTOWN, PA 18901 | $16K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $7K |
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 | 222 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CITIZENS SECURITY LIFE INSURANCE COMPANY | 70 | $31K |
| Vision | VISION BENEFITS OF AMERICA | 103 | $17K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 222 | $30K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 130 | $389K |
| Other | AMERICAN UNITED LIFE INSURANCE COMPANY | 222 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 222 | — |
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.