| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 400 HOLIDAY DRIVE, SUITE 210 PITTSBURGH, PA 15220 | ONEAMERICA | $4K | — | $4K | 1.30% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.31% |
| MARK A. SANTICHEN3 | 862 OLIM STREET JOHNSTOWN, PA 15904 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $37 | — | $37 | 2.81% |
| THERESA M. SANTICHEN3 | 862 OLIM STREET JOHNSTOWN, PA 15904 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $37 | — | $37 | 2.81% |
| LINETTE BLACKBURN3 | 969 EISENHOWER BOULEVARD JOHNSTOWN, PA 15905 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $33 | — | $33 | 2.50% |
| ABA WORKSITE INNOVATIONS, INC.3 Filed as: ABA WORKSITE INNOVATIONS INC | 203 SALMON AVENUE JOHNSTOWN, PA 15904 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $9 | — | $9 | 0.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $14 | $14 | — |
No Schedule C service providers reported on this filing.
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 | 380 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 43 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 423 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION BENEFITS OF AMERICA | 1,080 | $78K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 380 | $157K |
| Short-term disability | ONEAMERICA | 382 | $299K |
| Long-term disability | ONEAMERICA | 382 | $299K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 380 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,080 | — |
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.