| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 9.19% |
| 701 WESTTOWN ROAD LLC3 | 200 W LINCOLN HWY #A EXTON, PA 19341 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 8.00% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $324 | $0 | $324 | 0.95% |
| 701 WESTTOWN ROAD LLC3 | 200 W LINCOLN HWY #A EXTON, PA 19341 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | $0 | $2K | 9.04% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 6.27% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $219 | $0 | $219 | 0.92% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | $0 | $4K | 16.21% |
| 701 WESSTOWN ROAD LLC3 | 200 W LINCOLN HWY #A EXTON, PA 19341 | AMERICAN FIDELITY ASSURANCE COMPANY | $2K | $0 | $2K | 8.00% |
| PAA SERVICES INC3 | ATTN EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $0 | $241 | $241 | 1.01% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | -$25 | $0 | -$25 | -0.10% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | $0 | $3K | 17.89% |
| 701 WESSTOWN ROAD LLC3 | 200 W LINCOLN HWY #A EXTON, PA 19341 | AMERICAN FIDELITY ASSURANCE COMPANY | $1K | $0 | $1K | 8.00% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $175 | $0 | $175 | 0.95% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC. | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 303395946 | VISION SERVICE PLAN | $251 | $0 | $251 | 2.11% |
| 701 WESTTOWN ROAD LLC3 | 200 W LINCOLN HWY #A EXTON, PA 19341 | AMERICAN FIDELITY ASSURANCE COMPANY | $160 | $0 | $160 | 8.04% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $94 | $0 | $94 | 4.72% |
| PENNSYLVANIA AUTO ASSOC INS AGY INC3 | C/O EILEEN MAYFIELD INS DIRECTOR HARRISBURG, PA 17105 | AMERICAN FIDELITY ASSURANCE COMPANY | $18 | $0 | $18 | 0.90% |
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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 125 | $12K |
| Short-term disability(4 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 25 | $79K |
| Long-term disability(5 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 25 | $102K |
| Other(5 contracts) | AMERICAN FIDELITY ASSURANCE COMPANY | 25 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.