| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DELTA DENTAL OF NEW YORK0 Filed as: DELTA DENTAL OF WV | ONE DELTA DRIVE MECHANICSBURG, PA 17055 | DELTA DENTAL OF WEST VIRGINIA | — | $19K | $19K | — |
| DELAWARE VALLEY HEALTH CARE3 Filed as: DELAWARE VALLEY HEALTH CARE COALITI | 2980 SOUTHAMPTON ROAD PHILADELPHIA, PA 19154 | DELTA DENTAL OF WEST VIRGINIA | $1K | — | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD EIN 31-1440175 MEDICAL CLAIMS ADMIN | Float revenue; Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | 3075 VANDEREAR WAY CINCINNATI, OH 45209 | $385K |
| AMERICAN BENFIT CORPORATION EIN 55-0672859 PLAN ADMINISTRATOR | Plan Administrator; Other services Service code 14 | 9200 US-60 ONA, WV 25545 | $298K |
| FOSTER AND FOSTER EIN 59-1921114 PLAN ACTUARY | Actuarial Service code 11 | 184 SHUMAN BOULEVARD SUITE 305 NAPERVILLE, IL 60563 | $62K |
| CAPITAL RX PRESCRIPTION CLAIMS ADMIN | Claims processing Service code 12 | — | $55K |
| MACALA & PIATT EIN 34-1933033 ATTORNEY | Legal Service code 29 | 601 SOUTH MAIN STREET NORTH CANTON, OH 44720 | $40K |
| WEX HEALTH INC. HRA CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 843529 BOSTON, MA 02284 | $29K |
| TODD ASSOCIATES, INC INSURANCE AGENT | Insurance agents and brokers Service code 22 | 23825 CPMMERCE PARK SUITE A BEACHWOOD, OH 44122 | $12K |
| ALAN D BILLER ASSOCIATES, INC INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 535 MIDDLEFEILD ROAD, SUITE 230 MENLO PARK, CA 94025 | $10K |
| JOHNSON PRINTING PRINTING SERVICES | Copying and duplicating Service code 36 | 4136 GREEN VALLEY ROAD HUNTINGTON, WV 25701 | $6K |
| KOZOCKI HUGHES TICKERHOOF PLLC EIN 55-0526247 AUDITOR | Accounting (including auditing) Service code 10 | 32-20TH STREET, SUITE 300 WHEELING, WV 26003 | $5K |
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 | 567 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 318 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 885 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 318 | $657K |
| Dental | DELTA DENTAL OF WEST VIRGINIA | 1,514 | $0 |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 572 | $72K |
| Stop-loss / reinsurancereinsurance | BERKLEY ACCIDENT AND HEALTH | 0 | $556K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 572 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,514 | — |
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."
No prospect flags tripped on this filing.