| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $2K | $0 | $2K | 10.29% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | THE GUARDIAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 38.14% |
| PCI INSURANCE AGENCY3 Filed as: PCI INSURANCE, INC. | 417 WALNUT STREET HARRISBURG, PA 17101 | NATIONAL VISION ADMINISTRATOR, LLC | $310 | $0 | $310 | 8.19% |
| HIPPS CRYSTAL3 | 534 BETTY LANE COLUMBIA, PA 17512 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $182 | $0 | $182 | 7.85% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: ELEMENT RISK MANAGEMENT LLC | 310 HIGH ST WEST CHESTER, PA 19380 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $126 | $0 | $126 | 5.43% |
| TROCKI GEORGE3 | 221 PROSPECT CIRCLE SHREWSBURY, PA 17361 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $55 | $0 | $55 | 2.37% |
| JANE KULIKAUSKAS3 | 3022 NESCO RD HAMMONTON, NJ 08037 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $49 | $0 | $49 | 2.11% |
| SHANAMAN AMY JO3 | 84 MAIN ST P.O. BOX 71 STRAUSSTOWN, PA 19559 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $31 | $0 | $31 | 1.34% |
| CONWAY THERESA3 | 28 OAKGLADE DRIVE HUMMELSTOWN, PA 17036 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $30 | $0 | $30 | 1.29% |
| DOUGLAS C. PETERSON3 Filed as: DOUGLAS PETERSON | C598 RIVERWOOD AVE PT PLEASANT, NJ 08742 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $26 | $0 | $26 | 1.12% |
| BRISTOL ROBERT3 | 126 HARLOW POINTE COURT LANDENBERG, PA 19350 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PCI INSURANCE AGENCY EIN 25-1784573 BROKER | Insurance agents and brokers Service code 22 | 417 WALNUT STREET HARRISBURG, PA 17101 | $13K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $10K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $3K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $3K |
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 | 49 | 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) | 49 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 53 | $18K |
| Vision | NATIONAL VISION ADMINISTRATOR, LLC | 47 | $4K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY | 79 | $8K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 51 | $203K |
| Other | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 6 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 79 | — |
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.