| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TENTH DOT BENEFITS SOLUTIONS LLC3 | 444 LIBERTY AVE STE 750 PITTSBURGH, PA 15222 | HIGHMARK | — | — | $0 | 0.00% |
| EMBROOK BENEFITS CONSULTING, LLC3 | 1601 MEADOWBROOK ROAD JENKINTOWN, PA 19046 | CAPITAL ADVANTAGE ASSURANCE CO | $6K | — | $6K | 9.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | FIFTH AVENUE PLACE, 120 FIFTH AVE. PITTSBURGH, PA 152203099 | $287K |
| UPMC HEALTH PLAN EIN 25-1769564 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 600 GRANT STREET PITTSBURGH, PA 15219 | $10K |
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 | 236 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 236 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK | 342 | $457K |
| Dental | CAPITAL ADVANTAGE ASSURANCE CO | 68 | $61K |
| Vision(2 contracts, 2 carriers) | HIGHMARK | 342 | $519K |
| Prescription drug | HIGHMARK | 342 | $457K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.