| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHR BFT SVC INC | 2 PIERCE PLACE 14TH FLR ITASCA, IL 16143 | HM LIFE INSURANCE COMPANY | $47K | — | $47K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 210 INDUSTRIAL PARK DR STE 130 JOHNSTOWN, PA 15904 | HEALTHAMERICA OF PENNSYLVANIA, INC. | $33K | — | $33K | 17.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 400 HOLIDAY DRIVE FOSTER PLAZA #210 PITTSBURGH, PA 15220 | VISION BENEFITS OF AMERICA | $563 | — | $563 | 1.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 400 HOLIDAY DRIVE FOSTER PLAZA #210 PITTSBURGH, PA 15220 | DELTA DENTAL OF PENNSYLVANIA | $3K | — | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHAMERICA OF PENNSYLVANIA, INC. EIN 62-1411933 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | 750 PRIDES CROSSING, STE 200 NEWARK, DE 19713 | $191K |
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 | 514 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 514 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHAMERICA OF PENNSYLVANIA, INC. | 744 | $191K |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 766 | $0 |
| Vision | VISION BENEFITS OF AMERICA | 447 | $32K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 513 | $72K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 429 | $107K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 425 | $45K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HM LIFE INSURANCE COMPANY | 744 | $506K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 513 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 766 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.