| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS J. INGELSBY3 Filed as: THOMAS J INGELSBY | 400 BERWYN PARK, SUITE 200 899 CASSATT RD BERWYN, PA 19312 | MADISON NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 9.09% |
| NABCO5 | 20 VALLEY STREAM PARKWAY SUITE 310 MALVERN, PA 19355 | MADISON NATIONAL LIFE INSURANCE COMPANY | $0 | $3K | $3K | 7.44% |
| WILLIAM O DAGGETT JR3 Filed as: WILLIAM O. DAGGETT JR | 400 BERWYN PARK, SUITE 200 899 CASSATT RD BERWYN, PA 19312 | MADISON NATIONAL LIFE INSURANCE COMPANY | $1K | $673 | $2K | 4.60% |
| KT HOLDING CO, INC.3 | 400 BERWYN PARK, SUITE 200 899 CASSATT RD BERWYN, PA 19312 | MADISON NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.58% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY | 400 BERWYN AVE #200 BERWYN, PA 19312 | UNITED CONCORDIA INSURANCE COMPANY | $4K | $0 | $4K | 12.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA EIN 06-6033492 ADMIN | Claims processing Service code 12 | — | $23K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $11K |
| DIGITAL INSURANCE (KOP) BROKER | Insurance agents and brokers Service code 22 | 660 AMERICAN AVE SUITE 101 KING OF PRUSSIA, PA 19406 | $11K |
| 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 | 72 | 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) | 72 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 80 | $34K |
| Life insurance | MADISON NATIONAL LIFE INSURANCE COMPANY | 72 | $43K |
| Short-term disability | MADISON NATIONAL LIFE INSURANCE COMPANY | 72 | $43K |
| Stop-loss / reinsurancereinsurance | OPTUMHEALTH | 104 | $366K |
| Other | MADISON NATIONAL LIFE INSURANCE COMPANY | 72 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.