| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DILLER, JAMES C3 | 454 NEW HOLLAND AVE STE 300 LANCASTER, PA 17602 | HIGHMARK INC | $3K | $0 | $3K | 7.42% |
| LY, KIM L3 Filed as: LY, KIM LIN | 39 N DUKE ST LANCASTER, PA 17602 | HIGHMARK INC | $361 | $0 | $361 | 0.87% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF NJ | 20 COMMERCE DR STE 200 CRANFORD, NJ 07016 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $214 | $0 | $214 | 22.22% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE ST MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $54 | $0 | $54 | 5.61% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $1K | $6K | — |
| ASSUREDPARTNERS3 Filed as: AP BENEFIT ADVISORS LLC DBA CRAWFOR | 575 E SWEDESFORD RD STE 200 WAYNE, PA 19087 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $551 | $551 | — |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $437 | $437 | — |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 772 LITITZ PIKE LITITZ, PA 17543 | METROPOLITAN LIFE INSURANCE COMPANY | — | $19 | $19 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSURED PARTNERS (CENTRAL PA) EIN 30-0837157 BROKER | Insurance agents and brokers Service code 22 | — | $22K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $16K |
| HIGHMARK BLUE SHIELD (CENTRAL) EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $5K |
| CONNECTCARE3 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 | 63 | 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) | 63 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HIGHMARK INC | 107 | $41K |
| Vision | HIGHMARK INC | 107 | $41K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 50 | $217K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 2 | $963 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 107 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.