| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $787 | $0 | $787 | 7.58% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $654 | $0 | $654 | 6.30% |
| PAA SERVICES INC3 | ATTN EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $214 | $214 | 2.06% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $467 | $0 | $467 | 6.30% |
| PAA SERVICES INC3 Filed as: PAA SERVICES INC. | ATTN EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $134 | $134 | 1.81% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $375 | $0 | $375 | 29.30% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $81 | $0 | $81 | 6.33% |
| PAA SERVICES INC3 | ATTN EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $16 | $16 | 1.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $82K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $23K |
| GUNN-MOWERY BROKER | Insurance agents and brokers Service code 22 | P.O. BOX 900 CAMP HILL, PA 17001 | $12K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $6K |
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 | 128 | 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. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | HIGHMARK | 0 | $0 |
| Short-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 14 | $18K |
| Long-term disability(3 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 14 | $19K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 128 | $284K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.