| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AEGIS GENERAL INSURANCE AGENCY3 | 4507 NORTH FRONT STREET SUITE 200 HARRISBURG, PA 17110 | AXIS INSURANCE COMPANY | $455 | $0 | $455 | 10.01% |
| UNIVEST INSURANCE INC3 Filed as: UNIVEST INSURANCE, INC. | 521 WEST MAIN STREET PO BOX 391 LANSDALE, PA 19446 | AXIS INSURANCE COMPANY | $318 | $0 | $318 | 7.00% |
| UNIVEST INSURANCE INC3 Filed as: UNIVEST INSURANCE | 521 WEST MAIN STREET PO BOX 391 LANSDALE, PA 19446 | DELTA DENTAL OF PENNSYLVANIA | $257 | $0 | $257 | 9.98% |
| UNIVEST INSURANCE INC3 Filed as: UNIVEST INSURANCE | 1495 ALANWOOD ROAD SUITE 4 CONSHOHOCKEN, PA 19428 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $11 | $0 | $11 | 4.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNIVEST INSURANCE EIN 23-3021746 BROKER | Insurance agents and brokers Service code 22 | — | $2K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $1K |
| CAPITAL BLUECROSS EIN 23-0455154 CARRIER | Claims processing Service code 12 | — | $606 |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $306 |
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 | 99 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 57 | $3K |
| Vision | CAPITAL ADVANTAGE ASSURANCE COMPANY | 99 | $270 |
| Stop-loss / reinsurancereinsurance | OPTUM HEALTH (UNIMERICA INSURANCE COMPANY) | 56 | $16K |
| Other | AXIS INSURANCE COMPANY | 29 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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.