| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NATHAN MACIOCE3 | 4955 CHEYENNE COURT GIBSONIA, PA 15044 | HIGHMARK INC. | $54K | $0 | $54K | 2.49% |
| USI INSURANCE SERVICES LLC3 | 300 CORPORATE CENTER DRIVE SUITE 303 CAMP HILL, PA 17011 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $6K | $15K | 6.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $547 | $5K | 1.94% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | $0 | $8K | 7.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 444 LIBERTY AVENUE, SUITE 805 PITTSBURGH, PA 15222 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.86% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $3K | $3K | 2.66% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK INC. | 493 | $2.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $238K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $238K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 268 | $106K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 268 | $106K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 268 | $106K |
| Prescription drug | HIGHMARK INC. | 493 | $2.2M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 268 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 493 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.