| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 225 KENNETH DRIVE ROCHESTER, NY 14623 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 10.48% |
| CONSOLIDATED BENEFITS INC3 | 2500 ELMERTON AVE HARRISBURG, PA 17177 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $0 | $555 | $555 | 5.23% |
| PCI INSURANCE AGENCY3 | 417 WALNUT STREET HARRISBURG, PA 17101 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 11.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCI INSURANCE AGENCY EIN 25-1784573 BROKER | Insurance agents and brokers Service code 22 | 417 WALNUT STREET HARRISBURG, PA 17101 | $10K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $6K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $2K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $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 | 30 | 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) | 30 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 12 | $9K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 30 | $11K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 30 | $11K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 28 | $112K |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 30 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 30 | — |
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.