| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GORDON W ST JOHN3 Filed as: GORDON ST. JOHN | 453 GLENWYTH ROAD STAFFORD, PA 19087 | CONNECTICARE, INC. | $99K | $8K | $107K | 3.50% |
| PENTRA LLC3 Filed as: PENTRA, INC. | TWO VILLANOVA CENTER VILLANOVA, PA 19085 | DELTA DENTAL OF CONNECTICUT, INC. | $13K | — | $13K | 4.58% |
| PENTRA LLC3 Filed as: PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 190851525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $3K | $10K | 22.57% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 6.23% |
| PENTRA LLC3 Filed as: PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 190851525 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 44.52% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE, STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $50 | $50 | 0.20% |
| PENTRA LLC3 Filed as: PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 190851525 | VISION SERVICE PLAN | $1K | — | $1K | 4.64% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP D/B/A PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 190851525 | VISION SERVICE PLAN | $61 | — | $61 | 0.26% |
| PENTRA LLC3 Filed as: PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 190851525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $634 | $1K | $2K | 13.55% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $918 | $918 | 7.24% |
| PENTRA LLC3 Filed as: PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 190851525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $795 | $868 | $2K | 20.92% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $922 | $922 | 11.60% |
| PENTRA LLC3 Filed as: PENTRA, INC. | 795 E LANCASTER AVENUE, SUITE 210 VILLANOVA, PA 19085 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $556 | $556 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL INSURANCE CO. OF AMERICA EIN 22-1211670 NONE | Recordkeeping fees; Other services Service code 49 | — | $11K |
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 | 327 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 327 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CONNECTICARE, INC. | 460 | $3.1M |
| Dental | DELTA DENTAL OF CONNECTICUT, INC. | 547 | $286K |
| Vision | VISION SERVICE PLAN | 250 | $24K |
| Life insurance(6 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 327 | $147K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $0 |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 286 | $25K |
| Prescription drug | CONNECTICARE, INC. | 460 | $3.1M |
| Other(8 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 314 | $126K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 547 | — |
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.