| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIRST COMMONWEALTH INS AGCY INC3 Filed as: FIRST COMMONWEALTH INS AGENCY | 654 PHILADELPHIA BLVD INDIANA, PA 15701 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 20.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $515 | $515 | 5.00% |
| FIRST COMMONWEALTH INS AGCY INC3 Filed as: FIRST COMMONWEALTH INS AGENCY | 654 PHILADELPHIA ST INDIANA, PA 15701 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $846 | $0 | $846 | 19.99% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $212 | $212 | 5.01% |
| FIRST COMMONWEALTH INS AGCY INC3 Filed as: FIRST COMMONWEALTH INS AGENCY | 654 PHILADELPHIA ST INDIANA, PA 15701 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $748 | $0 | $748 | 19.99% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $187 | $187 | 5.00% |
| FIRST COMMONWEALTH INS AGCY INC3 Filed as: FIRST COMMONWEALTH INS AGENCY | 654 PHILADELPHIA ST INDIANA, PA 15701 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $238 | $0 | $238 | 20.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $59 | $59 | 4.96% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS | 225 WIRELESS BLVD STE 200 HAUPPAUGE, NY 11788 | VISION BENEFITS OF AMERICA | $49 | $0 | $49 | 5.00% |
| FIRST COMMONWEALTH INSURANCE AGENCY3 | 654 PHILADELPHIA ST INDIANA, PA 15701 | VISION BENEFITS OF AMERICA | $49 | $0 | $49 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UPMC BENEFIT MANAGEMENT SERVICES EIN 25-1844144 ADMIN | Claims processing Service code 12 | — | $11K |
| FIRST COMMONWEALTH INSURANCE AGENCY EIN 23-2929954 BROKER | Insurance agents and brokers Service code 22 | — | $4K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $3K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $786 |
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 | 51 | 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) | 52 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UPMC HEALTH BENEFITS | 101 | $7K |
| Vision | VISION BENEFITS OF AMERICA | 51 | $980 |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 61 | $4K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 61 | $4K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 61 | $10K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 45 | $104K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 61 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 101 | — |
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.