| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $997 | $0 | $997 | 10.12% |
| PAA SERVICES INC3 Filed as: PAA SERVICES, INC | ATTN EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $13 | $0 | $13 | 0.13% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 Filed as: PENNSYLVANIA AUTO ASSOC INS. AGY IN | C/O EILEEN MAYFIELD HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $736 | $0 | $736 | 8.00% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $655 | $0 | $655 | 7.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $35K |
| GUNN-MOWERY BROKER | Insurance agents and brokers Service code 22 | P.O. BOX 900 CAMP HILL, PA 17001 | $27K |
| 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 | — | $4K |
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 | 68 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 86 | 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 | 10 | $19K |
| Long-term disability(2 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 10 | $19K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 68 | $236K |
| 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."
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.