| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SWIFT KENNEDY FINANCIAL CO INC3 | 100 MEADOW LN #1 DUBOIS, PA 15801 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $33K | $0 | $33K | 3.39% |
| NICKLAS INSURANCE AGENCY INC3 | 101 MADISON ST SAINT MARYS, PA 15857 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $15K | $0 | $15K | 1.55% |
| GARY M. KLOBCHAR3 | 4104 CORK BOCKTOWN ROAD CLINTON, PA 15026 | AMERICAN UNITED LIFE INSURANCE COMPANY | $35K | — | $35K | 17.00% |
| BROOKVILLE INSURANCE AGENCY3 Filed as: BROOKVILLE INS AGENCY INC | 132 MAIN ST BROOKVILLE, PA 152851213 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 13.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK INC. EIN 23-1294723 NONE | Claims processing; Contract Administrator Service code 12 | — | $1.4M |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 NONE | Claims processing Service code 12 | — | $109K |
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 | 2,480 | 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) | 2,480 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION BENEFITS OF AMERICA | 2,393 | $398K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,157 | $1.0M |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,157 | $979K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,157 | $979K |
| Stop-loss / reinsurancereinsurance | HIGHMARK CASUALTY INSURANCE COMPANY | 910 | $293K |
| Other(3 contracts, 3 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,157 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,393 | — |
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.