| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT NETWORK, INC.3 | 115 VIP DRIVE #300 WEXFORD, PA 15090 | UPMC HEALTH OPTIONS | $43K | — | $43K | 2.85% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 Filed as: PENNSYLVANIA AUTO ASSOC INS AGY | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $8K | — | $8K | 5.89% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE CO | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | — | $4K | 3.13% |
| PAA SERVICES INC3 Filed as: PAA SERVICES, INC. | ATTN EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $2K | $2K | 1.54% |
| CHARLES J GETTY3 Filed as: CHARLES GETTY | 1037 SULLIVAN DRIVE HOMESTEAD, PA 15120 | AMERICAN FIDELITY ASSURANCE COMPANY | $818 | — | $818 | 0.62% |
| VINCENT RICHTAR3 | 2000 CORPORATE DRIVE SUITE 570 WEXFORD, PA 15090 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 9.48% |
No Schedule C service providers reported on this filing.
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 301 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UPMC HEALTH OPTIONS | 278 | $1.5M |
| Dental | UPMC HEALTH BENEFITS | 264 | $115K |
| Vision | HIGHMARK | 234 | $19K |
| Short-term disability(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 310 | $151K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 97 | $131K |
| Other | AMERICAN FIDELITY ASSURANCE COMPANY | 97 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 310 | — |
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.