| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIAM MUNRO3 | 525 CAPRI ROAD LANCASTER, PA 17603 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 11.00% |
| FRANCIS OSCILOWSKI3 | 2500 ELMERTON AVENUE HARRISBURG, PA 17177 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $587 | $0 | $587 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $31K |
| GUNN-MOWERY BROKER | Insurance agents and brokers Service code 22 | 650 N 12TH STREET LEMOYNE, PA 17043 | $10K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $9K |
| CONNECTCARE 3 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 | 48 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 48 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 52 | $12K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 48 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 52 | — |
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.