| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE DJB GROUP3 Filed as: THE DJB GROUP INC | — | DELTA DENTAL OF PENNSYLVANIA | $2K | $0 | $2K | 9.00% |
| THE DJB GROUP3 | 262 CHESTNUT STREET MEADVILLE, PA 16335 | HARTFORD LIFE AND ACCIDENT | $1K | $0 | $1K | 10.00% |
| HIGH STREET INSURANCE PARTNERS, INC3 | 305 WEST FRONT STREET TRAVERSE CITY, MI 49684 | HARTFORD LIFE AND ACCIDENT | $0 | $67 | $67 | 0.55% |
| THE DJB GROUP3 Filed as: THE DJB GROUP, LLC | 231 CHESTNUT ST STE 410 MEADVILLE, PA 16335 | HIGHMARK, INC. | $119 | $0 | $119 | 3.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $13K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $3K |
| HIGHMARK WEST EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | -$18K |
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 | 48 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 50 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 83 | $23K |
| Vision | HIGHMARK, INC. | 85 | $4K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 50 | $12K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 50 | $12K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 50 | $12K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 46 | $209K |
| Other | HARTFORD LIFE AND ACCIDENT | 50 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 85 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.