| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE ONE BENEFIT SOLUTIONS, LLC3 Filed as: EMPLOYEE ONE BENEFIT SOLUTIONS | 921 E. FORT AVE BALTIMORE, MD 21230 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 10.20% |
| MATHER & STROHL ADMIN SVCS INC3 Filed as: MATHER & STROHL ADMIN SVCS | 501 FAIRMOUNT AVE TOWSON, MD 21286 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | -$5 | — | -$5 | -0.01% |
| EMPLOYEE ONE BENEFIT SOLUTIONS, LLC3 Filed as: EMPLOYEE ONE BENEFIT SOLUTIONS | 921 E. FORT AVE STE 230 BALTIMORE, MD 21230 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 7.93% |
| BENEFIT MALL3 | 4851 LBJ FREEWAY STE 1100 DALLAS, TX 75244 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $723 | — | $723 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE INC EIN 35-1846036 NONE | Other services; Plan Administrator; Claims processing Service code 12 | 1280 N PLUM ST LANCASTER, PA 17601 | $120K |
| EMPLOYEE ONE BENEFIT SOLUTIONS EIN 20-8205286 NONE | Consulting (general); Insurance agents and brokers Service code 16 | 921 E. FORT AVE BALTIMORE, MD 21230 | $59K |
| AETNA - ASA EIN 06-6033492 NONE | Claims processing; Other services Service code 12 | 4400 NW LOOP 410 SAN ANTONIO, TX 78229 | $21K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Claims processing Service code 12 | 3331 QUALITY DR RANCHO CORDOVA, CA 95670 | $9K |
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 | 125 | 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 166 | $73K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 125 | $36K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 125 | $36K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 125 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 166 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.