| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PETERMAN BENEFITS3 | 105 MONTGOMERY AVE SUITE 2051 MONTGOMERYVILLE, PA 18936 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $669 | $0 | $669 | 0.14% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS CO | 899 CASSATT ROAD, SUITE 200 BERWYN, PA 19312 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $382 | $0 | $382 | 0.08% |
| PETERMAN BENEFITS3 | 105 MONTGOMERY AVE PO BOX 249 MONTGOMERYVILLE, PA 18936 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | $669 | $11K | 7.85% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS CO | 899 CASSATT ROAD STE 200 BERWYN, PA 19312 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $5K | $5K | 3.59% |
| PETERMAN BENEFITS3 | 105 MONTGOMERY AVE PO BOX 249 MONTGOMERYVILLE, PA 18936 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $0 | $8K | 12.00% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT RD 400 BERWYN PARK STE 200 BERWYN, PA 19312 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 3.00% |
| PETERMAN BENEFITS3 | 105 MONTGOMERY AVENUE PO BOX 249 MONTGOMERYVILLE, PA 18936 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 8.00% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT RD 400 BERWYN PARK STE 200 BERWYN, PA 19312 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $602 | $0 | $602 | 2.00% |
| PETERMAN BENEFITS3 | 105 MONTGOMERY AVE PO BOX 249 MONTGOMERYVILLE, PA 18936 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 12.00% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT RD 400 BERWYN PARK STE 200 BERWYN, PA 19312 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $619 | $0 | $619 | 3.00% |
| PETERMAN BENEFITS3 | 105 MONTGOMERY AVE PO BOX 249 MONTGOMERYVILLE, PA 18936 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $615 | $0 | $615 | 12.00% |
| KISTLER TIFFANY BENEFITS3 | 899 CASSATT RD 400 BERWYN PARK STE 200 BERWYN, PA 19312 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $154 | $0 | $154 | 3.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 ADMIN | Claims processing Service code 12 | — | $178K |
| PETERMAN BENEFITS BROKER | Insurance agents and brokers Service code 22 | 105 MONTGOMERYVILLE AVENUE P.O BOX 249 MONTGOMERYVILLE, PA 18936 | $75K |
| KISTLER TIFFANY BENEFITS BROKER | Insurance agents and brokers Service code 22 | 899 CASSATT ROAD 400 BERWYN PARK STE 200 BERWYN, PA 19312 | $26K |
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 | 403 | 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) | 403 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 0 | $488K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 274 | $136K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 274 | $136K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 403 | $30K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 120 | $64K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 134 | $21K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 403 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 403 | — |
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.