| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DR, STE 400 VALHALLA, NY 10595 | DELTA DENTAL OF PENNSYLVANIA | $5K | $0 | $5K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE SUITE 350 VAHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 9.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | $0 | $1K | 11.74% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY INC. | P.O. BOX 948 HENRIETTA, NY 14467 | COMPANION LIFE INSURANCE COMPANY | $242 | $0 | $242 | 14.98% |
| CONSOLIDATED BENEFITS INC3 Filed as: CONSOLIDATED BENEFITS INC. | 2500 ELMERTON AVE HARRISBURG, PA 17110 | COMPANION LIFE INSURANCE COMPANY | $121 | $0 | $121 | 7.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCI INSURANCE AGENCY BROKER | Insurance agents and brokers Service code 22 | 417 WALNUT STREET HARRISBURG, PA 17101 | $32K |
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $29K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $23K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $6K |
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 | 120 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 171 | $48K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 158 | $10K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 120 | $2K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY | 116 | $28K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 94 | $300K |
| Other | COMPANION LIFE INSURANCE COMPANY | 120 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.