| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COMMONWEALTH FINANCIAL GROUP3 | 2 BARLO CIRCLE, SUITE B DILLSBURG, PA 17019 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 5.24% |
| INDEPENDENCE PLANNING GROUP3 | 1767 SENTRY PKWY W BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14 | $0 | $14 | 0.03% |
| DONALD HEALEY3 Filed as: DONALD M HEALEY | 344 N FRONT ST WORMLEYBURG, PA 17043 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| U R L INC3 Filed as: U.R.L. INC | 500 NATIONWIDE DR HARRISBURG, PA 17110 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.00% |
| DONALD HEALEY3 Filed as: DONALD M. HEALEY | 344 N FRONT ST WORMLEYSBURG, PA 17043 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| U R L INC3 Filed as: U.R.L. INC. | 500 NATIONWIDE DR HARRISBURG, PA 17110 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.00% |
| COMMONWEALTH FINANCIAL GROUP3 | 2 BARLO CIRCLE, SUITE B DILLSBURG, PA 17019 | NATIONAL VISION ADMINISTRATORS LLC (NGL) | $230 | $0 | $230 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $28K |
| COMMONWEALTH BENEFITS GROUP BROKER | Insurance agents and brokers Service code 22 | 2 BARLOW CIRCLE SUITE C DILLSBURG, PA 17019 | $24K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $11K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $3K |
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 | 60 | 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) | 62 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 60 | $55K |
| Vision | NATIONAL VISION ADMINISTRATORS LLC (NGL) | 59 | $5K |
| Life insurance(2 contracts) | PRINCIPAL LIFE INSURANCE COMPANY | 68 | $59K |
| Short-term disability(2 contracts) | PRINCIPAL LIFE INSURANCE COMPANY | 68 | $59K |
| Long-term disability(2 contracts) | PRINCIPAL LIFE INSURANCE COMPANY | 68 | $59K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 60 | $234K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 68 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.