| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT CONNECTIONS, INC.3 Filed as: BENEFIT CONNECTIONS, INC | 43 EASTGATE DR STE 100 CARLISLE, PA 17015 | HARTFORD LIFE AND ACCIDENT | $526 | $0 | $526 | 15.01% |
| BENEFIT CONNECTIONS, INC.3 Filed as: BENEFIT CONNECTIONS, INC | 43 EASTGATE DR STE 100 CARLISLE, PA 17015 | DELTA DENTAL OF PENNSYLVANIA | $185 | $0 | $185 | 10.01% |
| BENEFIT CONNECTION3 | 43 EASTGATE DR STE 100 CARLISLE, PA 17015 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $20 | $0 | $20 | 4.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $2K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $1K |
| BENEFIT CONNECTION BROKER | Insurance agents and brokers Service code 22 | 43 EASTGATE DR STE 100 CARLISLE, PA 17015 | $1K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $270 |
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 | 37 | 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) | 37 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 58 | $2K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 55 | $497 |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 36 | $4K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 36 | $4K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 36 | $4K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 29 | $17K |
| Other | HARTFORD LIFE AND ACCIDENT | 36 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 58 | — |
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.