| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LILLIS MCKIBBEN BONGIOVANNI & CO3 Filed as: LILLIS, MCKIBBEN, BONGIOVANNI & CO | 100 STATE STREET ERIE, PA 16507 | HIGHMARK | $24K | — | $24K | 2.01% |
| LMBCO3 | 100 STATE STREET SUITE 300 ERIE, PA 16507 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $687 | $134 | $821 | — |
| LMBCO3 | 100 STATE STREET SUITE 300 ERIE, PA 16507 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $195 | $38 | $233 | — |
| LBMCO3 | 100 STATE STREET SUITE 300 ERIE, PA 16507 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $252 | $2K | — |
| LMBCO3 | 100 STATE STREET SUITE 300 ERIE, PA 16507 | EMPLOYEE SERVICES, INC. | $315 | — | $315 | — |
| LMBCO3 | 100 STATE STREET SUITE 100 ERIE, PA 16507 | HARTFORD LIFE AND ACCIDENT | $113 | — | $113 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED CONCORDIA COMPANIES EIN 25-1687586 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing Service code 12 | — | $6K |
| CIGNA DBA LIFE INS CO OF NORTH AMER EIN 23-1503749 | Claims processing Service code 12 | PO BOX 20643 LEHIGH VALLEY, PA 18002 | $2K |
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 | 94 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 94 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK | 257 | $1.2M |
| Vision | HIGHMARK | 257 | $1.2M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $0 |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $0 |
| Prescription drug | HIGHMARK | 257 | $1.2M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.