| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CONSOLIDATED BENEFITS INC3 | 2500 ELMERTON AVENUE HARRISBURG, PA 17177 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $5K | $1K | $6K | 20.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PATH ADMINISTRATORS EIN 46-1226464 NONE | Contract Administrator; Direct payment from the plan Service code 13 | 4785 LINGLESTOWN ROAD, SUITE 200 HARRISBURG, PA 171120480 | $55K |
| STUYVESANT CAPITAL MGT EIN 13-2953844 NONE | Direct payment from the plan; Investment management Service code 28 | 200 BUSINESS PARK DR SUITE 300A ARMONK, NY 10504 | $16K |
| CHARLES JOHNSTON PC EIN 23-2077724 NONE | Legal; Direct payment from the plan Service code 29 | 1011 ERFORD RD SUITE 302 CAMP HILL, PA 17701 | $11K |
| BENECARD EIN 22-2998772 NONE | Claims processing; Direct payment from the plan Service code 12 | 1200 ROUTE 46 WEST CLIFTON, NJ 07013 | $9K |
| ALAN ROSS & COMPANY, PC EIN 20-5367494 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 10 HEARTHSTONE COURT, SUITE 100 READING, PA 19606 | $9K |
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 | 121 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | HIGHMARK BLUE SHIELD | 160 | $18K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 160 | $29K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 160 | $29K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 151 | $349K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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."
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.